右胃大網動脈を用いた冠状動脈バイパス術後の早期胃癌に対する腹腔鏡下幽門側胃切除術の1例

A case of laparoscopic distal gastrectomy for early gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery

◆要旨：早期胃癌に対する腹腔鏡下胃切除術は今や標準術式となったが，右胃大網動脈を用いた冠状動脈バイパス術後には困難を伴い報告が少ない．症例は76歳の男性で，70歳時に右胃大網動脈を用いた冠状動脈バイパス術を施行された．健診での上部消化管内視鏡検査で胃前庭部に早期胃癌を認めた．また超音波検査，CT検査で胆囊内結石を認めた．右胃大網動脈グラフトは開存しており，これを温存し腹腔鏡下幽門側胃切除術，胆囊摘出術を施行した．腹腔鏡下手術は拡大視効果による安全確実な手技に加え，低侵襲性による早期離床が可能であり，有用であったと考えられた．

　We report a case of early gastric cancer with cholelithiasis after coronary artery bypass grafting（CABG） using the right gastroepiploic artery（RGEA） treated by laparoscopic distal gastrectomy and cholecystectomy. A 76-year-old male, who underwent CABG using the RGEA at the age of 70, was diagnosed as having an early gastric cancer in the antrum by endoscopy. Preoperative abdominal ultrasonography revealed cholelithiasis. We performed laparoscopic distal gastrectomy and cholecystectomy, while preserving the RGEA graft which remained patent. Laparoscopic surgery may have an advantage in safe nodal dissection under highly magnified operative view in this difficult clinical setting and may be useful for early ambulation owing to the less invasive procedure.