胃GISTに対する腹腔鏡下胃局所切除術—局在と発育形態に応じた手技の工夫と成績

Laparoscopic local resection for gastric stromal tumors:Different surgical procedures depending on tumor location and growth pattern

　胃GIST（gastrointestinal stromal tumor）に対して，局在と発育形態から術式を選択し，腹腔鏡下胃局所切除術23例（胃外アプローチ17例，胃内アプローチ6例）を施行した．自動縫合器による胃局所切除術を標準術式としたが，噴門・幽門近傍の症例には変形や狭窄を予防するため，漿膜筋層切離による腫瘍の胃壁外誘導や超音波凝固切開装置による全層切除などの手技の工夫を行った．局所再発の検討から胃GISTに対する局所切除術では，5mm以上のsurgical marginを確保した完全切除が重要と考えられた．本法は手技の工夫を行うことで噴門・幽門近傍の症例にも安全に実施でき，低侵襲で有用な術式である．

Twenty-three consecutive patients with gastric stromal tumors underwent laparoscopic local resections (17 exogastric and 6 intragastric resections). The surgical procedures were selected according to the location and growth pattern of the tumors. Standard surgical procedure was local wedge resection using endoscopic GLA sta-pler. The surgical procedures for tumors with intraluminal growth pattern and those located near the esophagogastric junction or the pyloric ring were exogastric resection with seromyotomy or full-thickness ex-cision using laparoscopic coagulation shears to prevent deformity or stenosis of the resected area.