腹腔鏡補助下に切除しえた十二指腸球部に脱出したポリープ状早期胃癌の2例

Type 0-I early gastric cancer prolapsed into the duodenal bulb : treatment by laparoscopy-assisted distal gastrectomy

◆要旨：十二指腸に脱出していたポリープ状早期胃癌の2例に対して腹腔鏡補助下手術を行った．［症例1］は64歳，男性．食後，突然の嘔気・嘔吐を認め，精査にて十二指腸球部に嵌頓した約6cmの0-I型早期胃癌を認めた．腹腔鏡補助下幽門側胃切除術（D1），Billroth I法再建を施行した．［症例2］は66歳，男性．食後の嘔気・心窩部痛を認め，精査にて十二指腸球部に嵌頓した2cm大の0-I型早期胃癌を認めた．腹腔鏡補助下幽門側胃切除術（D1＋α），Billroth I法再建を施行した．十二指腸に脱出したポリープ状早期胃癌に腹腔鏡補助下胃切除を行った報告はなく，貴重な症例であるため報告する．

　We report 2 patients with prolapsed type 0-I early gastric cancer into the duodenal bulb treated by laparoscopy-assisted distal gastrectomy（LADG）.

　Patient 1 : A 64-year-old man was admitted to our hospital with complaints of nausea and vomiting after eating. Endoscopic examination revealed transpyloric prolapse of a type 0-I early gastric cancer. The tumor size was approximately 55×40 mm. LADG was performed. Patient 2 : A 66-year-old man was admitted to our hospital with complaints of nausea and epigastralgia after eating. Endoscopic examination revealed transpyloric prolapse of a type 0-I early gastric cancer. The tumor size was approximately 18×20 mm. LADG was performed. Prolapse of the gastric cancer into duodenum is relatively rare and most of these lesions are type 0-I early gastric cancers. A review of recent reports in Japan indicated that most patients were treated by endoscopic polypectomy and open surgery. We report the first patients who underwent LADG for prolapsed early gastric cancers in Japan.