食道静脈瘤を伴った食道胃接合部癌に対して腹腔鏡下噴門側胃切除術を行った1例

Laparoscopic proximal gastrectomy in a patient for esophageal gastric cancer and esophageal varix

◆要旨：患者は70歳，男性．貧血を主訴に上部消化管内視鏡検査を行ったところ，アルコール性肝硬変による食道静脈瘤と食道胃接合部癌を指摘され当科に紹介となった．肝硬変はChild-Pugh分類Grade Bであった．静脈瘤は内視鏡的止血術の適応病変であったが，手術先行とし，腹腔鏡下噴門側胃切除術，D1郭清，食道残胃吻合を行った．術後経過は良好で第12病日に退院となった．食道静脈瘤を併発した食道胃接合部癌に対して腹腔鏡下噴門側胃切除術を施行した報告は検索しえなかった．術後1か月で行った上部消化管内視鏡検査にて静脈瘤の再発を認めていない．腹腔鏡手術は肝硬変患者に対しても低侵襲手術になりうると考え，報告する．

　A 70-year-old man was diagnosed as esophageal varices and esophagogastric junction cancer during follow up for alcoholic liver cirrhosis at another hospital. Laboratory data showed anemia and low serum albumin. CT showed moderate ascites, and the symptoms corresponded to the Child B criteria. Laparoscopic proximal gastrectomy and D1 lymphadenectomy was performed without endoscopic variceal ligation before surgery. The reconstruction was esophagogastrostomy. There was no postoperative complication, and the patient was discharged 12 days after surgery. As far as we know, the present case is the first report of esophagogastric junction cancer combined with esophageal varices successfully treated by laparoscopic proximal gastrectomy.