横隔膜弛緩症を合併した早期胃癌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 early gastric cancer in a patient with elevation of the diaphragm

◆要旨：患者は69歳，男性．上腹部痛を主訴に近医を受診し，上部消化管内視鏡検査で胃角部の早期胃癌を指摘され，当院を紹介されて受診した．精査の結果cT1b（SM）N0M0 StageⅠAの早期胃癌と診断した．胸部X線，胸腹部造影CTで左横隔膜弛緩症を認めた．またbody mass index 29.7と肥満1度であった．早期胃癌であること，深い視野での操作が予想されたこと，術後呼吸機能低下を軽減させることなどの理由から，腹腔鏡補助下幽門側胃切除術を行った．横隔膜弛緩症については無症状であり，処置は行わなかった．術後経過は良好で，第9病日に退院となった．手術後6か月現在，逆流症状を認めず無再発生存中である．

　A 69-year-old man visited a local clinic with a chief complaint of upper abdominal pain, and was referred to our hospital since upper gastrointestinal endoscopy revealed early gastric cancer at the gastric angle. The patient was finally diagnosed as cT1b（SM）N0M0 stage IA early gastric cancer. Chest X-ray and contrast-enhanced thoracoabdominal CT showed eventration of the left hemidiaphragm, and the patient's body mass index was 29.7, which indicated grade 1 obesity. Since the cancer was in the early stage and manipulations in a deep operative field were anticipated, to reduce postoperative respiratory dysfunction, laparoscopy-assisted distal gastrectomy was performed. Eventration of the diaphragm was subclinical and left untreated. The patient followed an uneventful postoperative course and was discharged on day 9. At six months postoperatively, he remains relapse-free without reflux symptoms.