腹腔鏡下Hassab手術先行により安全に一期的手術を行い得た胃食道静脈瘤併存胃粘膜下腫瘍の1例

Successful one-stage treatment of gastric submucosal tumor with esophageal and gastric varices by laparoscopic Hassab's surgery

◆要旨：食道胃静脈瘤に対するHassab手術において，完全腹腔鏡下に他部位の手術を同時施行した報告は，検索し得た限り1例もない．今回，胃粘膜下腫瘍を合併した食道胃静脈瘤に対し，腹腔鏡下Hassab手術とlaparoscopy and endoscopy cooperative surgery（LECS）での胃部分切除術を一期的に行い得た1例を経験した．症例は72歳女性．非B非C肝硬変による食道胃静脈瘤の増悪および胃粘膜下腫瘍の増大傾向を認めた．胃静脈瘤は胃粘膜下腫瘍上に及んでおり，腹腔鏡下Hassab手術およびLECSでの胃部分切除術を行った．脾機能亢進による血小板減少を呈していたが，術中内視鏡の使用により静脈瘤の消失を確認したうえで胃部分切除術を行ったことにより，安全な腹腔鏡下同時手術が可能であった．

　No reports have described surgery that combines Hassab's surgery with any other completely laparoscopic surgery. We performed laparoscopic Hassab's surgery and partial gastrectomy using laparoscopic and endoscopic cooperative surgery for esophageal and gastric varices with gastric submucosal tumor （SMT） in a one-stage surgery. The patient was a 72-year-old woman who had non-B non-C cirrhosis. The varices worsened, the SMT grew and the gastric varices covered the SMT. Laparoscopic Hassab's surgery and partial gastrectomy using laparoscopic and endoscopic cooperative surgery were performed. Although she had thrombocytopenia, we safely completed the laparoscopic surgery by using intraoperative endoscopy to ensure that the varices disappeared before partial gastrectomy.