横隔膜弛緩症を合併した食道胃接合部癌に対して腹腔鏡下噴門側胃切除を施行した1例

Laparoscopic proximal gastrectomy for adenocarcinoma of esophagogastric junction with diaphragmatic eventration

◆要旨：患者は70歳，男性．心窩部痛を契機に近医で施行した上部消化管内視鏡検査で食道胃接合部癌を指摘され，当院を紹介され受診した．胸部X線・胸腹部造影CTでは左横隔膜の著明な挙上を認めた．食道胃接合部腺癌（cT1b, N1, M0, cStageⅠB）および左横隔膜弛緩症と診断し，腹腔鏡下噴門側胃切除，D1＋（＋11d）郭清，double-tract再建術を施行した．術後経過は良好で，第12病日に退院となった．横隔膜弛緩症を合併した食道胃接合部癌に対して腹腔鏡下噴門側胃切除を施行した過去の報告は検索しえなかった．腹腔鏡下の良好な視野は，通常よりも深い左横隔膜下の操作において有用であったため報告する．

　A 70-year-old man visited a local clinic, complaining of epigastric pain. An upper gastrointestinal endoscopy revealed an adenocarcinoma at the esophago-gastric junction, and the patient was referred to our hospital. Chest X-ray and thoraco-abdominal CT showed marked elevation of the left diaphragm, leading to the following diagnosis : adenocarcinoma of esophagogastric junction combined with diaphragmatic eventration. Laparoscopic proximal gastrectomy followed by double tract reconstruction was performed. Postoperative course was uneventful and he was discharged on 12th postoperative day. As far as we know, the present case is the first report of esophagogastric junction cancer combined with diaphragmatic eventration successfully treated by laparoscopic proximal gastrectomy.