食道胃接合部癌に対し上体右半側臥位で胸腔鏡・腹腔鏡下下部食道胃全摘，胸腔内食道空腸吻合術を行った1例

Minimally invasive abdominal and left thoracic approach for Siewert typeⅡ adenocarcinoma of the esophagogastric junction : A case report

◆要旨：患者は56歳，女性．SiewertⅡ型食道胃接合部癌と診断され，手術目的に当科入院となった．手術は左胸腔・腹腔同時アプローチを用いた手技 minimally invasive abdominal and left thoracic approach （MALTA） に従い，開脚上体右半側臥位とし腹部操作から開始した．胃全摘D1＋郭清後，左胸腔アプローチによる人工気胸下に下部食道切除＋下縦隔リンパ節郭清を行い，胸腔内食道空腸吻合はリニアステイプラーを用いた機能的端々吻合とした．術後経過は良好で，術後第11病日目に退院となった．本術式は胸腔・腹腔操作の切り替えが簡便で同時操作もでき，経裂孔手術より広い角度からの胸腔操作が可能である点から食道胃接合部癌に対する有用な術式の1つと考えられた．

　A 56-year-old woman with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction was referred to our hospital for surgery. We performed minimally invasive abdominal and left thoracic approach（MALTA）. Following laparoscopic surgery, thoracoscopic surgery for inferior mediastinal lymph node dissection and esophagojejunostomy was performed. The postoperative course was good and she was discharged on the 11th day after the operation. MALTA makes it easier to switch between laparoscopic and thoracoscopic surgery than the prone position, and shows considerable advantages such as increased operative field exposure．MALTA for Siewert type Ⅱ adenocarcinoma is technically feasible.