AdachiⅥ型腹腔動脈走行破格を伴う胃癌に対する腹腔鏡下胃切除症例の検討

A study about gastric cancer with Adachi type Ⅵ vascular anomaly which was treated by laparoscopic gastrectomy

◆要旨：胃癌では膵上縁リンパ節の転移頻度が高く，十分な精度で安全に郭清する必要がある．これには総肝動脈とその前面の前肝神経叢を認識することが重要で，術前MDCTによる血管解剖把握が有用とされる．今回，この総肝動脈および前肝神経叢がその郭清の指標とならないAdachiⅥ型について，術前MDCT所見と手術所見を対比検討した．筆者らは腹腔鏡下胃切除症例に対して術前MDCTを施行しており，262例中7例をAdachiⅥ型と術前診断した．この全例でその破格を術中確認し，いずれも十分な膵上縁の郭清が可能であった．血管走行破格を術前に認識し，その特徴を熟知することが安全かつ正確な手術に有用であると考えられた．

Gastric cancer often metastasize to the suprapancreatic lymph nodes. So, it is necessary to dissect this lymph node with safety and accuracy. We need to recognize the common hepatic artery and nerve plexus on the artery for the dissection of the lymph nodes. Therefore, MDCT is a very useful device. We retrospectively reviewed laparoscopic gastrectomy for gastric cancer cases with Adachi typeⅥ vascular anormaly. We diagnosed seven cases of gastric cancer with Adachi typeⅥby MDCT who underwent laparoscopic gastrectomy. By the preoperative examination, we were able to perform the operation with accurate lymph dissection. It is very important to recognize and understand about vascular anomaly before the operation.