右胃大網動脈を用いた冠状動脈バイパス術後の胃癌に対する胃切除術兼再冠血行再建術

Simultaneous Surgery of Gastrectomy and Rerouting of the Pre-existing Right Gastroepiploic Artery Bypass Graft for Gastric Cancer

冠状動脈バイパス術（CABG）において，右胃大網動脈グラフト（RGEA）は右冠状動脈（RCA）領域にin situグラフトとして使用されている．しかし遠隔期に胃癌手術が必要になった際は，郭清のため切離を求められる場合がある．われわれは， RGEAを用いたCABG後に発症した進行胃癌に対し，右小開胸アプローチで上行大動脈に吻合した大伏在静脈グラフト（SVG）をRGEA末梢に吻合した後，胃切除術を同時施行した症例を経験したので報告する．

The patient was a 76-year-old man with advanced gastric cancer who had a history of coronary artery bypass grafting using the right gastroepiploic artery. Although coronary angiography confirmed the patency of all the coronary artery bypass grafts, his right gastroepiploic artery was required to be cut for curative gastrectomy. To prevent serious myocardial ischemia, rerouting of the right gastroepiploic artery graft was performed using a saphenous vein graft via right mini-thoracotomy. The proximal end of the saphenous vein graft was anastomosed to the ascending aorta. Then, gastrectomy via epigastric median re-laparotomy was performed. His postoperative course was uneventful.