当院での腹腔鏡下幽門側胃切除術における新三角吻合の治療成績

Intracorporeal triangular anastomosis for B-I reconstruction after laparoscopic distal gastrectomy

◆要旨：はじめに：当院では腹腔鏡下幽門側胃切除術における体腔内Billroth I（B-I）再建として新三角吻合を導入しており，治療成績について報告する．方法：2013年1月〜2022年8月までcStage I胃癌に対しLDG，新三角吻合を229例施行し，吻合部関連合併症などの治療成績を検討した．結果：縫合不全と吻合部狭窄をそれぞれ1例ずつ経験した．吻合に要した時間の中央値は21.5分であった．術後1年後の上部内視鏡検査においてRGB分類GradeⅢ以上は，残胃炎2例，残渣貯留25例を認めた．結論：新三角吻合は簡便な手技と虚血域となる十二指腸断端を切離することで安全な吻合を行うことが可能であり，有用な再建方法の1つであると考えられる．

　【Introduction】We introduced the intracorporeal triangular anastomotic technique in laparoscopic distal gastrectomy for gastric cancer. We describe the procedure and report treatment outcomes for the intracorporeal triangular anastomotic technique.【Method】From January 2013 to August 2022, 229 patients underwent intracorporeal triangular anastomotic technique in laparoscopic distal gastrectomy for cStageⅠgastric cancer. We investigated outcomes, including anastomosis-related complications.【Results】There was one case of postoperative leakage and one case of anastomotic stenosis grade≧3. The median anastomosis time was 21.5 minutes. Endoscopic food residue and gastritis grade≧3 based on the Residue, Gastritis, Bile classification system at one year after surgery were observed in 25 and 2 patients, respectively.【Conclusion】The intracorporeal triangular anastomotic technique is considered to be an useful reconstruction method because of its simple technique and safe anastomosis. This technique can be an option with Billroth I reconstruction in laparoscopic distal gastrectomy.