完全腹腔鏡下に十二指腸空腸吻合を行った上腸間膜動脈症候群の1例

An experience of laparoscopic duodenojejunostomy for superior mesenteric artery syndorme

◆要旨：患者は86歳，女性．嘔吐と腹部膨満を主訴に受診し，CTで腹部大動脈と上腸間膜動脈間の十二指腸水平脚圧迫と，胃から十二指腸の著明な拡張を認め，上腸間膜動脈症候群と診断した．保存的治療で一度改善したが再燃し，腹腔鏡下十二指腸空腸吻合術を施行した．十二指腸水平脚および下行脚を露出し，Treitz靱帯から約30cmの空腸と十二指腸水平脚を逆蠕動方向に自動縫合器で側側吻合を行い，挿入孔は牽引糸を腹腔鏡下でかけ自動縫合器で閉鎖し，完全腹腔鏡下で手術を終えた．上腸間膜動脈症候群に対する腹腔鏡下十二指腸空腸吻合において，側側吻合・挿入孔閉鎖いずれも自動縫合器を用いた本術式は完全腹腔鏡下での手技をより容易で安全にし，有用と考えられた．

An 86-year-old woman was admitted to our hospital complaining of vomiting. Abdominal computed tomography revealed marked distension of the stomach and stenosis in the third portion of the duodenum. The patient was diagnosed with superior mesenteric artery （SMA） syndrome. Conservative management was performed, but her symptoms soon recurred. We decided to perform laparoscopic duodenojejunostomy. We made incisions on the third portion of the duodenum and on the jejunum, 30cm distant from the ligament of Treitz, to laparoscopically introduce a cutting linear stapler. The incisions were stapled with the cutting linear stapler. Our operation method is an easier and safer surgical technique for treating SMA syndrome.