食道静脈瘤を伴った胃癌に対する腹腔鏡下胃切除術の1例

Successful laparoscopic distal gastrectomy in a patient with gastric cancer and esophageal varix

◆要旨：患者は69歳，男性．アルコール性肝硬変にて加療中，上部消化管内視鏡検査にて食道静脈瘤，早期胃癌と診断された．食道静脈瘤に対してendoscopic injection sclerotherapy，argon plasma coagulationが施行され，治療終了後に手術目的に当科に紹介された．手術は腹腔鏡下幽門側胃切除術（D 1＋α）を施行し，術中迅速病理にて口側断端が癌陽性となったため，追加切除を施行した．再建はRoux-en Y法を用いた．術後は順調に経過して，13日目で退院となった．肝硬変による食道静脈瘤を合併した早期胃癌に対して腹腔鏡下胃切除は有効な治療法と考えられた．

　A 69-year-old man was diagnosed as esophageal varices and early gastric cancer during follow up for alcoholic liver cirrhosis at another hospital. Endoscopic injection sclerotherapy（EIS）and argon plasma coagulation（API）was performed for esophageal varix. Thereafter, the patient was referred to our department for operation because the submucosal invasion of the gastric cancer was suspected. Laparoscopic distal gastrectomy（D 1＋α）was performed. Because the oral surgical margin of the resected stomach contained cancer by intraoperative rapid histopathological examination, we performed additional resection. The reconstruction was Roux-Y method. There was no postoperative complication, and the patient was discharged 13 days after surgery. Laparoscopic distal gastrectomy was thought to be effective method for early gastric cancer with esophageal varix.