胃切離を先行させる腹腔鏡下噴門側胃切除術の手術手技

Operative procedure of laparoscopic proximal gastrectomy after prior transection of the stomach

◆要旨：筆者らの行っている胃切離を先行させる腹腔鏡下噴門側胃切除の術式を紹介する．No.4dおよびNo.3の郭清範囲の決定後，術前の病変肛門側の点墨を十分に切除するように胃離断を行う．切除胃を把持牽引し，小彎側のNo.11p・No.7・No.8aの郭清を行う．その後切除胃を右側に牽引し，No.4sb・No.4saの郭清を行う．切除胃の牽引で術野展開は容易に行える．小開腹創から切除胃を摘出し，間置空腸を用いて再建を行う．これまで3例に行い，手術時間は平均227分で，平均出血量は70gであった．術後合併症はなく，術後在院期間は12日であった．筆者らの術式により短時間で安定した腹腔鏡下噴門側胃切除が可能となる．

　Herein, we show an operative procedure of the laparoscopic proximal gastrectomy after prior transection of the stomach. After the dissection part of No.4 d and No. 3 lymph nodes has been decided, we first perform the transection of the stomach at anal side of preoperative marking. While the resected stomach is grasped or pulled, the No.11 p, No.7 and No.8 a lymph nodes are dissected easily. After this, we pull a resected stomach to the right side of the patient and dissection of No.4 sb and No.4 sa lymph nodes are performed. We can easily show the clear operative field development by pulling the resected stomach. We then extract a resected stomach from a small laparotomy site at epigastric region and perform gastric reconstruction using a jejunal interposition. Three patients underwent this procedure. The average duration of the operation was 227 minutes and the amount of blood loss was 70 g. No postoperative complication was observed, and the average postoperative hospitalization was 12 days. Our operative method is useful for stabilization and shortening of the operative duration for laparoscopic proximal gastrectomy.