食道胃接合部近傍の胃粘膜下腫瘍に対してtransgastric approachによる腹腔鏡下胃局所切除術を施行した1例

Laparoscopic transgastric resection of gastric submucosal tumor located near the esophagogastric junction

◆要旨：胃粘膜下腫瘍に対する外科的治療は胃局所切除が選択されるが，食道胃接合部近傍に存在する腫瘍の場合は術後に狭窄や変形をきたす可能性があり，局所切除は決して簡単とはいえない．

　患者は42歳の女性．胃噴門部に径3.5cmの粘膜下腫瘍を認め，手術目的で入院となった．Transgastric approachによる腹腔鏡下胃局所切除術を施行した．病理組織学的所見より平滑筋腫と診断した．術後経過は順調で術後第11病日目に退院となった．

　本術式は，胃粘膜下腫瘍に対して腫瘍と管腔の位置関係を直視下に確認し，確実に管腔狭窄を避けることができる点で有効な術式と考えられたので報告する．

　Wedge resection of the stomach is suitable for the surgical treatment of submucosal tumors. However, for submucosal tumors located near the esophagogastric junction, this procedure is not easy, and caution should be taken to protect esophagogastric junction from postoperative stenosis or deformity.

A 42-year-old woman was admitted to our hospital for resection of a 3.5-cm gastric submucosal tumor located on the greater or anterior wall of the fornix, near the esophagogastric junction. Gastric submucosal tumor was diagnosed, and laparoscopic wedge resection by the transgastric approach was performed. The histological diagnosis was leiomyoma. The postoperative course was uneventful and the patient was discharged on the 11 th postoperative day.

This approach allows direct visualization of the tumor and better control of the surgical margin. It also produces less stenosis or deformity of the esophagogastric junction.