腹腔鏡補助下胃全摘術における自動吻合器を用いた再建術の工夫

Circular stapling Roux-en Y reconstruction after laparoscopy-assisted total gastrectomy

◆要旨：体上部から中部における12例の胃癌に対して腹腔鏡補助下の胃全摘術を施行した．手術手技は胃切除，リンパ節郭清，再建手技は可能な限り開腹術に準じて行っている．まず，腹腔鏡下にリンパ節郭清を施行し，次に上腹部に4～6cmの皮膚切開を行いMulti Flap Gate^TM（ジョンソン・エンド・ジョンソン社）を装着する．Tilte-Top-Plus^TM（タイコヘルスケアジャパン社）は腹部食道前壁を切開して直視下に挿入した．食道を離断後に，創より手縫いにてかがり縫いを施行した．この小切開創からEEA自動吻合を用いた食道・空腸吻合を行う．小開腹創から小腸・小腸吻合を行い，Roux-en Y再建が完了する．このTilte-Top-Plus^TMとEEA自動吻合器を用いた胃全摘術における食道・空腸吻合術は安全で容易でシンプルな方法の1つである．

　We performed laparoscopy-assisted total gastrectomy for twelve cases of gastric cancer in the upper and middle regions of the stomach. As a general rule, the stomach resection, lymph node dissection and reconstruction were performed in the same manner as conventional open surgery. First, we performed lymph node dissection for gastric cancer, and we made a small incision（4-6 cm）in the upper abdomen. Muti Flap Gate^TM（MFG）（Johnson & Johnson, U.S.A）was fitted to the wound in order to insert the Tilte-Top-Plus^TM（Covieden, U.S.A.）. The Tilte-Top-Plus was introduced from the abdominal esophagus, and the tabacoo-suture was a stitched hand maneuver from a small incision. The Roux-en Y reconstruction was carried out by the circular stapling technique with EEA. Postoperative complication from anastomosis were not seen. We consider the circular stapling Roux-en Y reconstruction to be a safe, easy, and simple method of amastmosis in laparoscopic total gastrectomy.