成人肥厚性幽門狭窄症に対し腹腔鏡下幽門側胃切除術を施行した1例

A case of laparoscopic distal gastrectomy for benign hypertrophic pyloric stenosis in an adult

◆要旨：症例は68歳，男性．17年前より嘔気，胸やけを自覚し，上部消化管内視鏡検査で幽門狭窄を指摘されていた．悪性所見は認めず経過観察されていたが，症状の増悪を認め，手術加療目的に当科を紹介受診した．当院で施行した上部消化管内視鏡検査では，幽門狭窄が高度でスコープは通過不能であった．上部消化管造影検査ではstring sign，造影剤の通過障害を認め，CTでは幽門部に全周性の壁肥厚を認めた．良性幽門狭窄症の診断で腹腔鏡下幽門側胃切除術を施行した．病理組織所見で悪性所見は認めず，幽門部の固有筋層に肥厚を認めた．成人肥厚性幽門狭窄症は稀な疾患でこれまで腹腔鏡下手術の報告はなく，文献的考察を加え報告する．

　A 68-year-old man complaining of nausea and heartburn had been observed for pyloric stenosis for 17 years. Endoscopy was performed regularly and no malignancy was detected by biopsy. During the course of follow up, thickening of pylorus and shortening of antrum progressed gradually and his symptoms became stronger. Therefore, he was referred to our hospital for surgery. When we performed upper gastrointestinal endoscopy, the endoscope could not pass the pylorus because of severe stenosis. Biopsy showed no finding of malignancy. Upper gastrointestinal series showed a string sign of the pylorus and obstruction of the passage for contrast medium. CT scan showed circumferential thickening of the pylorus. Benign pyloric stenosis was diagnosed and laparoscopic distal gastrectomy was performed. Histopathological examination confirmed the diagnosis with no finding of malignancy and revealed thickening of the proper muscular layer. Since hypertrophic pyloric stenosis in adult is rare and there has been no report of laparoscopic surgery for this disease, we present our case with literature review.