腹腔鏡下胃全摘術における食道断端へのアンビル固定の工夫

A novel and safe technique for esophagojejunostomy using the direct inserted anvil after laparoscopy assisted total gastrectomy

◆要旨：【背景】腹腔鏡下胃全摘後再建における，食道断端への新しいアンビル固定法を考案した．本手術手技を報告する．【方法】①食道に全層縦切開を加えアンビルヘッドを挿入する．②first anchor suture（切開口側），③second anchor suture（切開肛門側）を加え，④アンビル近傍でliner stapler（LS） を用い食道を切断する．⑤staple lineとアンビルとの固定を行う．【結論】本法は特殊な器具を要せず，アンビルヘッドの挿入のみで固定が可能な，容易かつ安全な手技である．

［Background and object］ A “direct anvil insertion method'' is a newly devised technique for safe and easy reconstruction after laparoscopic assisted total gastrectomy. We report the points of direct insertion of the anvil after laparoscopic assisted total gastrectomy. ［Method］ At first, an incision of approximately 1.5cm is created in the anterior esophagus wall, and an anvil tied with 2-0 monofilament nylon was inserted into the abdomen. ① anvil head is inserted into the esophagus. ②first anchor suture（oral side of the esophagus）. ③second anchor suture（anal side of the esophagus）. ④resection of the esophagus near the anvil using liner stapler（LS）. ⑤staple line is tied up with the anvil. ［Conclusion］ This method has an advantage for its safety without any blind procedures. It is also a simple method that does not require any special devices and techniques.