腹腔鏡補助下幽門保存胃切除術を施行したAdachi Ⅵ型の総肝動脈走行異常を示す早期胃癌の1例

Laparoscopy-assisted pylorus preserving gastrectomy for early gastric cancer with Adachi type VI vascular anomaly : a case report

◆要旨：症例は61歳，男性．早期胃癌に対する治療目的で当院に紹介となった．術前のmultidetector-row computed tomography（MDCT）で，AdachiⅥ型の総肝動脈の走行異常が指摘されたが，門脈前面を露出しつつNo.8aリンパ節郭清を行うことで，D1＋βリンパ節郭清を伴う腹腔鏡補助下幽門保存胃切除術を安全に施行可能であった．AdachiⅥ型は膵上縁，門脈腹側に総肝動脈がみられず，2群リンパ節郭清の際に問題となる血管走行異常である．腹腔鏡下手術では，触診による動脈走行の把握は困難であり，術前のMDCTによる血管走行の把握は，安全に手術を遂行するうえで極めて重要であると考えられた．

　A 61-year-old Japanese man was referred to our hospital for further examination of early gastric cancer. Multidetector-row computed tomography（MDCT）showed a vascular anomaly of Type VI in Adachi's classification. The patient was treated successfully with laparoscopy-assisted pylorus-preserving gastrectomy with D1＋beta lymph node dissection. Adachi's Type VI is a rare vascular anomaly where the common hepatic artery does not appear at the superior border of the pancreas. Since the palpation cannot be performed in laparoscopic surgery, the running pattern of the artery cannot be confirmed during the operation. Therefore, in order to perform laparoscopic surgery safely, it is very important to understand the arterial running pattern prior to surgery by using MDCT.