脳室腹腔シャントを有する胃癌患者に対して腹腔鏡下幽門側胃切除術を施行した1例

Laparoscopic distal gastrectomy for gastric cancer in a patient with ventriculoperitoneal shunt

◆要旨：患者は87歳，女性．以前に正常圧水頭症に対して脳室腹腔シャント（VPS）留置術を施行されていた．上部消化管内視鏡検査にて胃角部小彎に径40mmの0-Ⅱa＋Ⅱc型胃癌および前庭部小彎に径10mmの0-Ⅱa型胃癌が認められた．VPSが逆流防止機構付きであり，特別な処置をすることなく腹腔鏡下幽門側胃切除術を施行した．術後経過に異常はなかった．近年，VPS留置例に対する腹腔鏡下手術症例の報告が散見されるようになってきたが，胃癌手術の報告例はごくわずかである．逆流防止機構付きVPS症例においては，特別な処置をすることもなく合併症なく腹腔鏡下幽門側胃切除術施行できる可能性が示唆された．

The patient was an 87-year-old female with a past history of normal pressure hydrocephalus that was treated by ventriculoperitoneal shunt surgery. The shunt tube contained an anti-reflex valve. Upper gastrointestinal endoscopy revealed two early gastric cancers in the antrum and at the angle. Laparoscopic distal gastrectomy was performed safely without any procedure performed on the shunt tube, and the patient was discharged without any complications. Recently, the use of laparoscopic surgery in patients with ventriculoperitoneal shunt has been reported ; however, reports of this procedure in patients with gastric cancer are limited. The current report indicates that laparoscopic surgery is safe in patients with gastric cancer who have been previously treated with ventriculoperitoneal shunt tube with an anti-reflex valve.