腹腔鏡下胃切除術における神経温存手術の工夫

Technical device for laparoscopy-assisted distal gastrectomy with autonomic nerve preservation for early gastric cancer

◆要旨：自律神経温存胃切除術は，胆石の発生や消化機能の低下を防止し，術後長期のQOLの向上をもたらす．一方，腹腔鏡下手術は低侵襲で，術後合併症が少なく，術後の回復が早いなど，術後短期のQOLが高い．当科では術後短期のみならず，長期のQOLの向上を目標として，自律神経を温存した腹腔鏡補助下胃切除術を行っている．この手術では腹腔鏡下に前迷走神経幹の肝枝，後迷走神経幹の腹腔枝，肝神経叢の温存を行う．神経温存手技を行ううえで，腹腔鏡下における自律神経系の臨床解剖の理解と，視野の展開法が特に重要である．腹腔鏡下に自律神経を温存するリンパ節郭清は安全に行うことができ，早期胃癌に対して推奨される術式である．

　Autonomic nerve sparing distal gastrectomy is a procedure that has been introduced to improve the quality of life（QOL）for patients with early gastric cancer. Laparoscopic surgery provides the good short-term QOL. We have introduced laparoscopic distal gastrectomy with autonomic nerve preservation to improve both the short-term and long-term QOL for patients with early gastric cancer. Autonomic nerve sparing gastrectomy involves preserving the hepatic branches of the anterior vagal trunk, celiac branches of the posterior vagal trunk and hepatic plexus. In nerve preservation, it is especially important to understand the surgical anatomy of the autonomic nerves and to make a good surgical field under laparoscopy to identify the nerves. Laparoscopy assisted distal gastrectomy with autonomic nerve preservation is a feasible and safe method, and it is recommended to patients with early gastric cancer.