腹腔鏡下胃固定術を施行した成人胃軸捻症の1例

A case of laparoscopic gastropexy for adult gastric volvulus

◆要旨：患者は78歳，女性．2006年，著明な腹痛と嘔吐を主訴に来院した．腹部X線およびCT検査上，胃軸捻症が疑われた．経鼻胃管による減圧を施行し，上部消化管造影で長軸と短軸両方に捻転を認めたが，患者の希望で経過観察となった．3か月後に再捻転したため，腹腔鏡下胃固定術を行った．まず胃穹窿部と横隔膜を1針固定，さらに大彎前壁に4針を縫合し，おのおの直上のポート孔から縫合糸を出して直視下に腹膜および筋膜に縫合し，大彎が尾側に伸展されるように固定した．術中内視鏡で内腔の開存を確認した．術後経過は良好で，翌日から経口開始し，第5病日目に退院し，術後約2年現在，再発は認めない．胃軸捻症の治療には腹腔鏡下手術は低侵襲で有効な可能性がある．

　A 78-year-old female was admitted to our hospital because of severe epigastralgia and vomiting in 2006. Chest X ray radiogram and CT revealed gastric volvulus. Nasogastric decompression was attempted. Upper gastrointestinal tract examinations using barium revealed stomach twists both along the major axis and the minor axis. The patient preferred to be observed rather than to be operated. Three months later, however, laparoscopic gastropexy was performed because of the reccurence of gastric volvulus. During the operative procedure, the fornix of the stomach and the diaphragm were first sutured with laparoscopic knot tying technique. Then 4 sutures were added on the anterior serosa along the greater curvature. Each suture was taken out of the abdomen, and was fixed to the peritoneum and fascia of the rectal muscle, thus spreading the greater curvature towards the legs. We confirmed the patency of the stomach by endoscope. The patient had a good post-operative course ; she could eat the next day of the operation, and was discharged 5 days after the operation. Since then, there has been no recurrence. Laparoscopic operation can be effective and may be considered as one of the minimally invasive therapies for gastric volvulus.