右胃大網動脈を用いた冠動脈バイパス術後の胃癌に対して腹腔鏡下幽門側胃切除を行った2例

Laparoscopic distal gastrectomy after coronary artery bypass grafting using the right gastroepiploic artery : Report of Two cases

◆要旨：右胃大網動脈（RGEA）を用いた冠動脈バイパス術（CABG）施行後の胃癌に対して腹腔鏡下幽門側胃切除術（LDG）を施行した2症例を経験した．症例1は72歳の男性で，胃体下部に早期癌を認めた．ESDを施行したが断端陽性となり，追加切除を要した．術前の血行再建はリスクを伴うため，RGEA温存のLDG, D1＋郭清を行った．症例2は87歳の男性で，胃前庭部前壁に2型の進行癌を認めた．RGEAを温存しLDG, D1＋郭清を行った．CABGグラフトとして用いたRGEAは胃前庭部の腹側を走行しており，開腹幽門側胃切除術においても損傷の可能性がある．腹腔鏡下手術はその拡大視効果と繊細な操作により，グラフト損傷のリスクを軽減する可能性がある．

We experienced two cases of patients who underwent laparoscopic distal gastrectomy（LDG） for gastric cancer after coronary artery bypass grafting（CABG） using the right gastroepiploic artery（RGEA）. Case 1, a 72-year-old man, was diagnosed as having early gastric cancer located in the lower part of the stomach. We performed ESD, but positive resection margins required further treatment. Because preoperative redo CABG poses risks, we performed LDG and D1 ＋ lymph node dissection, preserving the RGEA. Case 2, an 87-year-old man, was diagnosed as having Type2 advanced gastric cancer located in the anterior antrum of the stomach. We performed LDG and D1 ＋ lymph node dissection preserving the RGEA. Because the RGEA, which is used as the graft in CABG, runs along the ventral side of the antrum, it might be injured during gastrectomy even in open surgery. LDG could decrease the risk of injury to the RGEA graft, because of the laparoscopic magnification of the operating field, and the delicacy of the procedure.