腹腔鏡下胃手術における簡単な肝圧排方法

New method to retract liver for laparoscope-assited gastrectomy

◆要旨：これまでの腹腔鏡下胃手術時の肝圧排方法のうち，肝三角間膜に穴を開けペンローズドレーン中央部の糸を引き出して腹壁に固定し，両端を左右に引き上げ肝を圧排する方法は，効率はよいが習熟が必要である．心窩部にポートを追加し，食道裂孔部を把持しながら肝を圧排する方法は，簡便だが圧排の効率がよくない．筆者らは両者の利点を合わせて簡便な肝圧排方法を考案した．5cmのペンローズドレーンの両端に糸をかけて結紮し，一方は1cm程度の輪に，他方は1本の糸にする．肝鎌状靭帯の右側にポートを穿刺し，エンドクリンチII^Ⓡでペンローズドレーンの輪の部を把持したまま食道裂孔部を把持し固定する．反対側の糸を左上腹部に引き出し固定後，鉗子とペンローズドレーンとで肝を圧排する．簡便で習熟も不要であり，肝の圧排効率も良好である．

　The method to retract the liver using the Penrose drain through the hole opened in the triangle ligament of the liver is useful for laparoscope-assisted gastrectomy. However, the procedure requires the trained skill and the experience of laparoscopic surgery. We created the new method to easily retract the liver. Penrose drain, 5 cm long, and EndclinchII^Ⓡwere used. Both end of the Penrose drain were sutured with 1-0 Nylon thread. At one end the thread was ligated into circle and at the other end it remained as a thread. Endclinch II^Ⓡwas inserted through the 5 mm port of the epigastrium. After the circle of the Penrose drain was held with Endclinch II^Ⓡ, the esophageal hiatus was grasped with it. The thread of another end was pulled out of the abdominal wall and fixed. Then the liver was retracted successfully. This method needs no special technique and is very easy to perform for the surgeons with few experience of laparoscopic surgery.