経腟的標本摘出法による完全腹腔鏡下手術を施行した胃・大腸癌の重複癌症例

Laparoscopic synchronous distal gastrectomy and sigmoid colectomy for double cancer with transvaginal specimen extraction

◆要旨：当科では腹腔鏡下手術のさらなる低侵襲性を求め経腟的標本摘出（transvaginal specimen extraction：TVSE）を行っている．TVSEは整容性の向上,創痛の軽減，低侵襲性が期待される．症例は76歳，女性．S状結腸に進行癌，胃前庭部に0-Ⅱc病変を認めた．手術は胃のD1＋郭清を定型5ポートで行い，右下腹部に5mmポートを加え，S状結腸D3郭清を行った．結腸切離後に，胃切を行い，両標本を経腟的に摘出した．結腸はDST吻合，胃はRY再建（胃空腸吻合：機能的端端吻合・Y吻合：circular stapler）を体腔内で行った．後腟円蓋は経腟的に縫合閉鎖した．術後は創痛も軽微であり合併症なく第11病日に退院した．重複癌に対するTVSEによる完全腹腔鏡下手術について若干の考察を加えて報告する．

We performed a complete laparoscopic surgery with transvaginal specimen extraction in order to further minimize surgical invasiveness. We believe that transvaginal specimen extraction is a more cosmetic, less painful, and less invasive method. The patient was a 76-year-old female who underwent colonoscopy to evaluate anemia and gastroenteroscopy for preoperative screening. The results showed a type 2 lesion in the sigmoid colon and a 0-Ⅱc lesion in the gastric antrum. Operation was performed by inserting a 12-mm-diameter port through the umbilicus under open method. Five ports were made in the form of a reverse trapezoid to permit distal gastrectomy. Lymph node dissection was performed prior to gastrectomy to prevent any specimen degradation that might be caused by ischemia. After addition of a 5-mm-diameter port through the right inferior abdomen, laparoscopic sigmoid colectomy and gastrectomy followed by transvaginal specimen extraction were performed. The colon was anastomosed using a double-stapling technique. A functional gastrojejuno end-to-end anastomosis using an automatic suturing device was created and side-to-side Y-limb anastomosis employing a circular stapler was performed. After anastomosis, the posterior vaginal fornix was closed with a V-lock, commencing at the vagina. The patient was discharged on postoperative day 11. We report a patient with double cancer treated via synchronous laparoscopic distal gastrectomy and sigmoid colectomy, featuring transvaginal specimen extraction. A literature review is added.