腹腔鏡下胃全摘術における食道空腸吻合時の食道粘膜-筋層固定の工夫

Technique to tie a surgical thread to the esophageal mucosal and muscle layers in esophagojejunostomy during laparoscopic total gastrectomy

◆要旨：Linear staplerを使用した食道空腸吻合において，食道粘膜と筋層のずれを予防するための固定を容易かつ確実に行う工夫を報告する．経口または経鼻的に18Frセイラムサンプチューブを麻酔医に挿入してもらい，食道断端にチューブを押し付け,これをガイドに同部位に小孔をあける．小孔の断端から約1cm口側で食道の外から食道内腔のチューブに向けて垂直に針を刺入し，チューブ内腔に針先を留置する.術者が鉗子でチューブを約2cm腹腔内に牽引すると，チューブに突き刺さった針がチューブとともに食道内腔から腹腔内に引き出されてくる．針糸を牽引し，糸を結紮すると食道粘膜-筋層の固定が完成する．

　We report herein a simple and reliable technique used in esophagojejunostomy to tie a suture to the esophageal mucosal and muscle layers during laparoscopic total gastrectomy. An anesthesiologist inserts a 18 Fr Salem sump tube and presses the tube against the edge of the esophageal stump while the operator makes a small hole in the same site. The operator then inserts a needle perpendicular to the esophageal wall from outside the esophagus into the sump tube at a position about 1 cm from the stump and pierces the tube so that its tip is inside the tube lumen. As the operator pulls the tube about 2 cm into the abdominal cavity with forceps, the needle is pulled out together with the tube from the esophageal lumen into the abdominal cavity. Then the operator ligates the suture to fix the esophageal mucosal and muscle layers in position.