腹腔鏡補助下幽門保存胃切除術におけるリンパ節郭清の工夫

Technical points of lymph node dissection for laparoscopy assisted pylorus preserving gastrectomy

◆要旨：胃癌の好発部位である胃体下部病変に対する幽門保存胃切除術は，手技的に腹腔鏡補助下手術に非常に応用しやすい術式である．腹腔鏡補助下幽門保存胃切除（laparoscopy assisted pylorus preserving gastrectomy：LAPPG）の問題点は幽門洞周囲のリンパ節郭清精度と，術後の食物停滞である．腹腔鏡の拡大視効果を生かした膜を意識した手術によりリンパ節郭清の精度は格段と向上し，術後食物停滞も手技の完全定型化と幽門洞の血流・神経温存により7％の頻度に抑えることができる．LAPPGを長期・短期においてquality of lifeに優れた術式とするために，機能温存とリンパ節郭清を両立した手技を紹介する．

　Pylorus-preserving gastrectomy（PPG）with extensive lymph node dissection is an effective treatment for early gastric cancer while preserving the gastric function. This technique could be further improved by using laparoscop. Comparing LAPPG and conventional open PPG（CPPG）procedures, there was no significant difference in the number of lymph nodes retrieved for each nodal station. The clinical outcomes suchas estimated blood loss and postoperative complication for gastric cancer patients who underwent LAPPG were comparable to those treated with CPPG. The LAPPG is technically feasible and has an important role in the surgical management of early gastric cancer. It has better quality of postoperative life.