食道裂孔ヘルニアを伴う胃GISTに対して腹臥位胸腔鏡下胃部分切除を施行した1例

A case of gastric GIST with hiatal hernia treated by thoracoscopic partial gastrectomy in prone position

◆要旨：食道裂孔ヘルニアにより縦隔内に脱出した胃穹窿部に発生した胃gastrointestinal stromal tumor（GIST）に対して腹臥位胸腔鏡下に胃部分切除を施行した1例を経験したので報告する．患者は85歳，女性．高度の亀背を伴い，経腹的な縦隔操作が困難であると予測され，腹臥位胸腔鏡下に胃部分切除を施行した．病理組織学的には紡錘形腫瘍細胞が増生しており，免疫組織染色検査ではc-kitおよびCD34が陽性であった．腫瘍径は29×26mm，核分裂像は4/50HPFで，低リスクGISTと診断された．良好な視野で安全で低侵襲な手術を施行することが可能であった．

We report a case of a gastric gastrointestinal stromal tumor（GIST） migrated to the mediastinum due to the presence of hiatal hernia. The patient was an 85-year-old woman with severe kyphosis. Because of this, it was anticipated that laparoscopic surgery or laparotomy may be difficult. The tumor, measuring 29×26mm, was resected thoracoscopically in the prone position with artificial pneumothorax. Histopathologically, the tumor was composed of spindle-shaped cells with a mitotic count of 4/50HPF. These tumor cells were positive for c-kit and CD34 on immunohistochemistry. Based on these findings, the tumor was diagnosed as a low-risk GIST. Thoracoscopic approach in the prone position with artificial pneumothorax was a less invasive and beneficial surgical procedure in this case.