切除不能幽門狭窄胃癌に対する腹腔鏡下部分的曠置的胃空腸吻合術の1例

A case of laparoscopic partial partitioning gastrojejunostomy for unresectable gastric cancer with pyloric stenosis

◆要旨：切除不能幽門狭窄胃癌に対して腹腔鏡下部分的曠置的胃空腸吻合術を施行した1例を経験したので報告する．患者は62歳，男性で，食事摂取困難を主訴に内視鏡検査を施行し，胃体中下部にType 3腫瘍を認め，幽門狭窄胃癌と診断された．Staging laparoscopyを施行したところ，横隔膜，肝円索に播種性病変を認め，原発巣も切除不能と判断され，バイパス術を施行した．バイパス術は腹腔鏡下部分的曠置的胃空腸吻合術を施行した．術後3日目より経口摂取が可能となり，術後造影での通過も良好で，10日目に退院となった．腹腔鏡下部分的曠置的胃空腸吻合術は幽門狭窄胃癌に対する姑息手術として有用であると考えられた．

　A 62-year-old man was referred to our hospital for appetite loss and epigastric pain. Upper gastrointestinal endoscopy showed a type III tumor in the middle and lower body of the stomach, and gastric roenterography showed pyloric stenosis. Disseminated nodules were found in the diaphragm and the ligament of the liver by staging laparoscopy. A curative operation was impossible for the advanced gastric cancer. Therefore, a laparoscopic partial partitioning gastrojejunostomy was performed to allow oral intake. Oral intake was started 3 days after the operation, and he left hospital 10 days after the operation. Postoperative roenterography showed good passage to jejunal loop. This case suggested that the laparoscopic partial partitioning gastrojejunostomy was a useful method for treating unresectable gastric cancer with pyloric stenosis.