十二指腸に嵌頓した胃原発GISTに対して腹腔鏡補助下幽門側胃切除術を施行した1例

Laparoscopy assisted distal gastrectomy for incarcerated gastrointestinal stromal tumor into duodenal cap

◆要旨：患者は83歳，女性．黒色便を主訴に近医を受診し，十二指腸に嵌頓する胃粘膜下腫瘍を指摘された．内視鏡的に整復を試みるも還納は不能であった．当院での生検結果はGroup 1であり，腹腔鏡下に腫瘍を鉗子で還納し，腹腔鏡補助下幽門側胃切除術を施行した．病理組織診断は中リスク（gastrointestinal stromal tumor；以下，GIST）で，リンパ節転移はなかった．術後経過は良好で術後14日目に転院となった．2010年10月までに胃原発GISTが脱出した報告は10例のみであった．今回，筆者らは十二指腸に嵌頓した胃原発GISTに対して腹腔鏡下に胃腫瘍を還納し，腹腔鏡補助下幽門側胃切除術を施行した1例を経験した．このような術式で治療しえた症例は本邦において第1例目であり報告する．

　An 83-year-old woman was admitted to another hospital because of dizziness, staggering gait, and black stool. Severe anemia was pointed out and gastric submucosal tumor incarcerated into duodenal cap was detected by endoscope. Repositioning of the tumor by endoscope was impossible. The patient was referred to our institution because of surgical treatment. The result of the biopsy at our institution was non-neoplastic tissue. Laparoscopy assisted distal gastrectomy （LADG） was performed. The surgical findings showed that the lymph nodes were not swollen. The incarcerated tumor was repositioned laparoscopically. Histological diagnosis was gastrointestinal stromal tumor （GIST） （intermediate risk group）, and there was no lymph node metastasis. Postoperative course was uneventful and the patient was referred back to the previous hospital on the 14^th post operative day.