膵炎症状を呈した胃異所性膵に対して腹腔鏡・内視鏡合同手術を施行した1例

Surgical treatment of gastric aberrant pancreas with acute pancreatitis by laparoscopic and endoscopic cooperation surgery : Report of a case

◆要旨：胃異所性膵は無症状で経過し偶然発見されることが多い．通常は経過観察となるが，有症状や増大傾向，悪性疾患鑑別のために手術治療となることがある．膵炎症状を伴った胃異所性膵に対して，腹腔鏡・内視鏡合同手術（laparoscopic endoscopic cooperation surgery：LECS）を施行したので報告する．患者は46歳，女性．乳癌診断時に胃異所性膵と診断し画像にて経過観察を行ってきたが，繰り返し膵炎症状を呈したため手術治療を施行した．腫瘍は胃体部小彎側にあり，腫瘍辺縁を内視鏡で全周粘膜切開を行い貫通部位から腹腔鏡下操作で切除を進めた．術後の経口摂取は良好でLECS手技を行うことで胃切除量を最小限にすることが可能となり，機能温存をしつつ安全に手術を施行することができた．

　Gastric aberrant pancreas is usually of no clinical symptom and most cases are found accidentally during endoscopy or surgery. Conservative management is appropriate in an asymptomatic patient, however operation is available for symptomatic, enlarging tumors, and is suggested if diagnostic uncertainty remains. We report a case of acute pancreatitis in gastric aberrant pancreas treated with laparoscopic endoscopic cooperation surgery （LECS）. A 42-year-old woman who was diagnosed with gastric aberrant pancreas underwent left mastectomy for breast cancer. She often complained of epigastralgia frequently at 4-year follow up after surgery and examinations revealed gastric aberrant pancreas with acute pancreatitis. Therefore surgical resection was performed by LECS. The tumor was located at the lesser curvature of her stomach and marked by endoscopic submucosal dissection technique. The circumference around the tumor was dissected using ultrasonical scalpel after the artificial perforation was performed. This procedure allows safe tumor resection with minimal resection area of the stomach wall and would be preferable in functional preservation such as oral ingestion.