腹腔鏡下胃癌手術における左側アプローチによる迷走神経温存術

Preservation of vagus nerve technique using left-sided approach in laparoscopy-assisted distal gastrectomy

◆要旨：腹腔鏡下胃切除の対象は早期あるいはそれに類似する進行胃癌が多く，長期QOLに配慮した迷走神経温存術式の選択が望ましい．迷走神経は通常その前幹肝枝と後幹腹腔枝を温存するが，これまでの腹腔鏡下手術での腹腔枝温存法はかなり煩雑であった．このため腹腔鏡下手術で腹腔枝を簡便に温存する新しい術式を考案した．2005年に筆者らが独自に開発した左胃膵ひだに対する左側アプローチ法を利用して左胃動脈の根部で腹腔枝を同定し，そこから中枢に向ってこれを追及して温存する方法である．この方法をこれまで迷走神経温存を計画した304例に行い全例で確実に温存が可能であった．その工夫などについて紹介する．

　Laparoscopy-assisted gastrectomy is mainly performed for early or early-like advanced gastric cancer, and it is preferable to perform the vagus nerve preserving operation to maintain long-term quality of life. In preservation of vagus nerve, celiac branch and hepatic branch are generally preserved, but in conventional laparoscopic surgery, preservation of celiac branch has been so demanding. In 2005, we developed a new surgical procedure to easily preserve the celiac branch. With the use of left-sided approach for left gastropancreatic fold, a method we had developed, the celiac branch is identified at the root of the left gastric artery, and from there, celiac branch is followed and persevered toward its center. By using this method, preservation was conducted definitely in all of 304 patients undergoing vagus-nerve preserving gastrectomy. Here, we describe our new technique.