難治性再発性胃出血に対して腹腔鏡補助下幽門側胃切除術を施行した遺伝性出血性毛細血管拡張症の1例

A case report of laparoscopy- assisted distal gastrectomy for the treatment of refractory recurrent gastric bleeding in a patient with hereditary hemorrhagic telangiectasia

◆要旨：患者は78歳，男性．35年前に遺伝性出血性毛細血管拡張症と診断された．5年前から胃出血を繰り返すようになり，内視鏡的止血術および輸血療法を繰り返していた．出血頻度の増加による外科的治療の適応に関して，当科に紹介となった．上部消化管内視鏡検査では，胃全域に拡張血管が存在し，体下部小彎側の拡張血管から出血を認めた．難治性再発性胃出血と判断し，腹腔鏡補助下幽門側胃切除術，Roux-en Y再建を施行した．術後出血などの合併症は認めず，経過良好で術後12日目に退院した．遺伝性出血性毛細血管拡張症の難治性出血例に対して腹腔鏡補助下胃切除術を施行した報告は極めて少ないが，外科的治療の選択肢の1つと考えられた．

A 78-year-old man who was diagnosed as having hereditary hemorrhagic telangiectasia（HHT） thirty-five years ago, had repeated gastric bleeding for five years. Because endoscopic hemostasis and blood transfusion were performed frequently to control the bleeding, the patient consulted us for possible indication of surgical treatment. Upper gastrointestinal endoscopy showed angioectasia in the entire stomach mucosa and bleeding in the lesser curvature of the lower gastric body. We performed laparoscopy-assisted distal gastrectomy（LADG） and Roux-en Y reconstruction for refractory recurrent gastric bleeding. The patient was discharged 12 days after surgery without any complications. There have been only a few reported cases of HHT with refractory recurrent gastric bleeding treated by LADG, one of the choices for surgical treatment of HHT.