上腸間膜動脈性十二指腸閉塞症に対し腹腔鏡下十二指腸・空腸吻合術を施行した2例

Two cases of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome（SMA syndrome）

◆要旨：上腸間膜動脈性十二指腸閉塞症（以下，SMA症候群）の2例に対し腹腔鏡下十二指腸・空腸吻合術を施行した．［症例1］は11歳，男児．栄養療法を行ったが奏効せず手術を施行した．手術は腹腔鏡下にEndo-GIA^TMを用いて十二指腸第3部と空腸の側々吻合を行い，GIA挿入部は体腔内で縫合・閉鎖した．術後，症状は軽快した．［症例2］は14歳，女児．中心静脈栄養を併用した栄養療法を行ったが改善せず手術を行った．［症例1］と同様の手術手技で行ったが，術後吻合部の狭窄を認めて再手術が必要となった．SMA症候群に対する十二指腸・空腸吻合を内視鏡下に行うことは可能であるが，同術式を安全・容易に行うためにはさらに工夫が必要である．

　Two cases of superior mesenteric artery（SMA）syndrome that were treated by laparoscopic duodenojejunostomy are reported. （Case 1）A 11-year-old boy was operated by laparoscopy because conservative management was unsuccessful. A duodenojejunostomy was performed by Endo-GIA and the remaining enterostomy introduced. The Endo-GIA insertion hole was closed using interrupted suture. After operation there is no recurrence of symptoms. （Case 2）A 14-year-old girl, was operated because of failure of conservative management with intravenous hyperalimentation. Operative procedure was almost the same as case 1. However, re-operation with laparotomy was needed because of stenosis of the anastomosis. We think that laparoscopic duodenojejunostomy for SMA syndrome is a feasibre procedure but more improvement is needed to penform it safely and easily.