食道胃接合部へ達する胃大型GISTに対して腹腔鏡下胃局所切除術を施行した1例

A case of laparoscopic surgery for gastrointestinal stromal tumor reaching esophagogastric junction

◆要旨：患者は86歳，女性．気分不良のため受診した．精査にて胃穹窿部大彎に8cm大の胃粘膜下腫瘍を認め，待機的に腹腔鏡下胃局所切除術を施行した．腫瘍が食道胃接合部に達し，食道粘膜を胃内に引き込んでいたため慎重に切除範囲を決定した．胃壁欠損部の閉鎖は層々吻合法にて腹腔鏡下に縫合閉鎖することで胃の変形を最小限に抑え，食道の狭窄などを起こすことなく閉鎖できた．術後合併症などなく術後15日目に退院となった．食道胃接合部に達する腫瘍を切除する際は，術後の変形，狭窄などの可能性を考慮し，噴門側胃切除術を選択することがあるが，切開・閉鎖方法を工夫することで，より低侵襲である腹腔鏡下胃局所切除術を施行することが可能であった．

An 86-year-old woman had a medical examination complaining of fatigue. Gastrointestinal fiberscope revealed a giant tumor of approximately 8 cm in size in the lower gastric mucosa at the greater curvature of the fornix. Therefore, laparoscopic gastric partial resection via 5 ports was performed. The tumor border had reached the esophagogastric junction and due to its weight, had pulled the esophageal mucosa into the stomach. The tumor was excised carefully. By using laparoscopic hand suturing technique, the deformation of the stomach was minimized and the structure of the esophagus was preserved. The patient was discharged from our hospital on postoperative day 15 without complications. When considering the possibility of esophagogastric deformation and stenosis after the removal of tumor reaching esophagogastric junction, proximal gastrectomy may be chosen as surgical treatment. By using the closedown method described in this study, laparoscopic partial gastrectomy was possible and was less invasive.