術前3D Multi-Detector CTにて血管走行異常と診断した早期胃癌患者に対する腹腔鏡補助下幽門側胃切除術の1例

A case of laparoscopic gastrectomy and lymph node dissection in a early gastric cancer patient with Adachi type VI group 28 vascular anomaly

◆要旨：AdachiⅥ型は総肝動脈が門脈腹側・膵上縁に認められない型で約2％の頻度とされる．今回筆者らはAdachiⅥ型28群の破格と考えられた胃癌症例に対して腹腔鏡下切除を行ったので報告する．患者は77歳，男性．胃体中部大彎後壁の早期胃癌の診断で術前3D-MDCTを施行した．CTにて総肝動脈を認めず，上腸間膜動脈より右肝動脈・胃脾動脈幹より左肝動脈が分岐し，AdachiⅥ型28群の破格を認めた．手術は腹腔鏡補助下幽門側胃切除・D1+β郭清を施行し，術中もMDCTと同様の血管分岐を確認した．AdachiⅥ型の破格は少なからず存在し，術前3D-MDCTは術中合併症を回避するためにも有用であると考えられた．

　Adachi classified branches from the celiac axis into six types. In Adachi typeⅥ, the common hepatic artery（CHA）can not be detected at the superior border of the pancreas, and the frequency is about two percent. A 77-year-old male, diagnosed with gastric cancer, underwent multidetector-row computed tomography and 3 D-angiography to clarify the vascular anatomy preoperatively. By these radiological examinations, we were able to make a preoperative diagnosis with Adachi typeⅥgroup 28 vascular anomaly and could perform laparoscopic gastrectomy and lymph node dissection safely. It is useful to understand the vascular anatomy prior to surgery with multidetector-row computed tomography and 3 D-angiography to improve surgical safety.