腹腔鏡補助下胃癌手術における手縫いBillroth I法再建

Hand-sewn Billroth I anastomosis in laparoscopy-assisted distal gastrectomy for gastric cancer

◆要旨：筆者らは早期胃癌に対する腹腔鏡補助下幽門側胃切除時に小切開創からの手縫いBillroth I法再建を行っている．小切開は十二指腸球部の高さで約5cmの正中切開を行う．吻合はAlbert-Lembert法にて行うが，後壁Lembert縫合糸を切離せずに残しておく．この縫合糸を牽引して後壁全層を挙上すると良好な視野が得られ，後壁Albert縫合を安全に行うことができる．これまでに早期胃癌50症例に施行し，縫合不全を認めなかった．その手術手技や工夫などについて紹介する．

　The procedures for stapled Billroth I anastomosis in laparoscopy-assisted distal gastrectomy （LADG） for gastric cancer has been well established. However, little has been reported about hand-sewn Billroth I anastomosis in LADG. The purpose of this article was to introduce our surgical technique under these circumstances. The 5 cm midline incision was created at the level of duodenum bulb. Albert-Lembert suture was used for this anastomosis. The ligated strings of Lembert suture were used to lift up the posterior walls of remnant stomach and duodenum. Then Albert suture safely passed through both the posterior walls. We have performed this anastomosis in LADG for 50 early gastric cancer patients since 2006 and none of these patients have had postoperative anastomotic leakage.