術中超音波併用腹腔鏡下胃部分切除術を施行したdelleを伴う胃GISTの2例

Two cases of gastric gastrointestinal stromal tumor with delle treated by laparoscopic ultrasound-guided partial gastrectomy

◆要旨：症例1は51歳，女性．胃角後壁に約4cmのdelleを認める消化管間質腫瘍（gastrointestinal stromal tumor：以下，GIST）と診断された．症例2は59歳，女性．胃体下部小彎後壁に約3cmのdelleを認めるGISTと診断された．手術はともに術中超音波併用腹腔鏡下胃部分切除術を施行した．手術は胃を反転した状態で固定し，腫瘍はいずれも後壁に認めたため，腹側へ移動させた．術中超音波検査を行い，腫瘍辺縁を同定しマーキングした．胃内腔を露出しないように漿膜筋層を全周に切開した．腫瘍を挙上し，切除胃が最小限となるように自動縫合器で切除した．術中超音波検査併用によりGIST辺縁の同定が可能になることから術中内視鏡が不要となり，手術室内と術野がよりシンプルとなり，有用な方法と考えられた．

　Case 1 was a 51-year-old woman diagnosed with an approximately 4 cm gastrointestinal stromal tumor（GIST）with delle on the posterior wall of the gastric antrum. Case 2 was a 59-year-old woman diagnosed with an approximately 3cm GIST with delle on the posterior wall of the gastric lesser curvature. The patients underwent laparoscopic ultrasound-guided partial gastrectomy. The stomach was fixed in an inverted position, and the tumor was transferred to the ventral side. Intraoperative ultrasonography was performed to identify and mark the tumor margins. A full circumferential incision was made through the serosal muscularis mucosae to avoid exposure of the gastric lumen. The tumor was elevated and resected using stapling devices to minimize the length of resection. Intraoperative ultrasonography allows identification of the tumor margins, eliminating the need for an intraoperative endoscope and simplifying the operating room and the surgical field.