左乳房有茎腹直筋皮弁再建例に腹腔鏡下幽門側胃切除術を施行した早期胃癌の1例

Laparoscopic distal gastrectomy after reconstructive mammaplasty with pedicled rectus abdominis musculocutaneous flap : a case report

◆要旨：患者は47歳，女性．45歳時に左乳癌に対し乳房全摘，センチネルリンパ節生検，右腹直筋による有茎腹直筋皮弁再建を行った．47歳時に心窩部痛を訴え，精査を行ったところ胃癌と診断され手術治療を行った．筋皮弁の走行を術前に超音波にて確認，マーキングし，栄養血管を損傷しないようにポートを挿入した．完全腹腔鏡下幽門側胃切除術を行った．患者は術後8病日に退院し，術後約1年を経過したが再建組織の萎縮や腹壁瘢痕ヘルニアなどは認めず，整容性を保ちつつ根治術を行うことができた．完全腹腔鏡下幽門側胃切除術は腹壁の破壊を最小限にすることができるため，有茎腹直筋皮弁による乳房再建を行った患者に対し有効な手段であると考えられた．

　A 47-year-old woman who had reconstructive mammaplasty with pedicled rectus abdominis musculocutaneous flap after mastectomy for breast cancer two years ago visited our hospital with complain of upper abdominal pain. Upon closer inspection, the patient was diagnosed with gastric cancer. We placed the trocar at a safe position by confirming the presence of musculocutaneous flap and feeding vessels by echography. We then performed laparoscopic distal gastrectomy. The patient was discharged eight days after surgery without any complications. There is no atrophic change in the reconstructed breast or abdominal incisional hernia at one year of follow up. Laparoscopic distal gastrectomy may be useful for patients with reconstructive mammaplasty with pedicled rectus abdominis musculocutaneous flap because of its minimally invasive incisions.