成人特発性胃軸捻転症に対して腹腔鏡下胃固定術を施行した1例

A case of laparoscopic gastropexy for adult idiopathic gastric volvulus

◆要旨：患者は69歳，女性．悪性リンパ腫の寛解状態にて経過観察されていた．嘔吐，腹部膨満にて受診し，腹部X線およびCTにて胃軸捻転症と診断され内視鏡的整復術を行った．その7か月後，11か月後にも胃軸捻転症を再発し内視鏡的整復術を行った．待機的手術が可能であったため腹腔鏡下胃固定術を行った．捻転解除時の胃の形態や胃軸捻転の先進部を確認し，胃底部横隔膜固定を3針，胃小彎と肝円索を1針固定した．合併症なく第5病日に退院となった．術後4年再発なく経過し栄養状態は安定している．胃軸捻転症に対して腹腔鏡下胃固定術は低侵襲で有効な治療法であり，胃軸捻転の先進部を胃の自然な形態で固定することが重要と考えられた．

　A 69-year-old female was followed in complete remission state of malignant lymphoma at our hospital. She was admitted because of vomiting and abdominal distension. Abdominal X-ray and CT revealed gastric volvulus. We repositioned the stomach via endoscopic detorsion. The volvulus recurred seven and 11 months later and we performed endoscopic repositioning. We performed laparoscopic gastropexy electively because her general condition was stable. We confirmed the normal shape of the stomach and leading parts of gastric volvulus in preoperative examination and intraoperation carefully. We detected the leading parts and sutured the fornix of the stomach and the diaphragm by three knot ties, round ligament of the liver and lesser curvature of the antrum by one knot tie. The patient had a good postoperative course and was discharged 5 days after the operation. There was no recurrence for four years and the patient remained in stable condition. Laparoscopic gastropexy for gastric volvulus is considered an effective, minimally invasive treatment. It is important to fix the leading parts to keep the normal shape of the stomach.