臍部切開創を利用した腹腔鏡補助下幽門側胃切除Billroth-I法再建の工夫

The improvement in laparoscopy-assisted distal gastrectomy and Billroth-I reconstruction by using the umbilical incision

◆要旨：Laparoscopy-assisted distal gastrectomy（LADG）におけるBillroth-I法再建には種々の吻合法が考案されている．筆者らは簡便で安全な腹腔鏡下の切除・吻合法を新たに開発した．本法は，小切開を上腹部ではなく臍部に置くことで整容性に優れ，自動吻合器を用いるため吻合口径が術者や熟練度に左右されない．また，腹腔鏡下の手縫い縫合や熟練した技術を要する手技が少なく，再建に要する時間も短縮され，術者側にとってもストレスの軽減となる．さらに，腸管クリップを使用することで自動縫合器の使用数を削減し，自動縫合器・吻合器も加算限度内ですみ，医療施設にとっても有益な方法である．当科ではこの臍からの自動吻合器を用いた方法をtrans-umbilical circular stapling（TUCS）B-I法と呼んでいる．

　Various anastomotic methods have been developed for Billroth-I reconstruction after laparoscoy-assisted distal gastrectomy（LADG）. Here we report our new simple and easy laparoscopic gastrectomy and anastomotic techniques which have shown some advantages. Our method has an advantage aesthetically by using only a small incision in the umbilical region and not in the upper quadrant. The diameter of anastomosis does not vary according to the surgeon's skill because our technique uses an automatic anastomosis device. There are also advantages for the patient. Our new method does not require laparoscopic hand-sewn suture or expert techniques. Our method shortens the reconstruction time and reduces the stress for the surgeons. Furthermore, our method reduces the number of the automatic suture devices by using reusable intestinal grips and therefore offers advantage to the medical institution. We named this new method as the trans-umbilical circular stapling（TUCS）B-I method.