腹腔鏡下胃全摘術におけるD2リンパ節郭清の工夫

Laparoscopic total gastrectomy with D2 standard radical lymph node dissection for gastric carcinoma

◆要旨：胃癌に対する腹腔鏡下手術は機器の進歩と手技の向上および定型化に伴い胃上部病変に対する胃全摘術にまで適応が拡大されている．しかしD2リンパ節郭清を伴う腹腔鏡下胃全摘術はその中でも脾門および膵尾部周囲のリンパ節郭清を行わねばならないため最も難易度が高い．本稿では本術式を行うにあたって脾臓摘出を伴う術式，脾臓温存でNo10リンパ節をサンプリングする術式さらに膵体尾部切除を伴う術式の解剖の認識，術野の展開，手術手技および手順を概説した．

　With the advancement of surgical tools and technical standardization, laparoscopic gastrectomy has become a widely used treatment for patients with gastric carcinoma that require total gastrectomy. However, laparoscopic total gastrectomy with D2 standard radical lymph node dissection is considered to be one of the most complicated procedures because the lymphadenectomy should be extended around the splenic hilum and along the distal side of the splenic artery. We herein describe the surgical anatomy, exploration of better operative views and technical procedures of laparoscopic total gastrectomy with D2 standard radical lymph node dissection accompanied by splenectomy. We also refer to the procedure without splenectomy and the procedure with distal pancreatectomy and splenectomy.