単孔式内視鏡手術で腹腔鏡下胃瘻造設術を行った癌性食道狭窄の1例

Laparoscopic gastrostomy using a SILS port as treatment for esophageal malignant stricture after chemoradiotherapy

◆要旨：高度進行食道癌で内視鏡挿入が困難な患者には，経皮内視鏡的胃瘻造設術が施行できない．従来，開腹下に胃瘻造設術を行うか，腹腔鏡用ポートと2本のワーキングポートで腹腔鏡下胃瘻造設術が行われるのが一般的である．近年，内視鏡外科の手術手技が改良され，より少ないポートでより低侵襲な手術術式が試みられている．今回，筆者らは高度進行食道癌に対する根治的化学放射線治療後も内視鏡挿入が困難な患者に対して，サルベージ治療としてSILS^TMポートから腹腔鏡および鉗子を挿入し腹腔鏡下胃瘻造設術を施行した．本術式は，安全かつ簡便で低侵襲に胃瘻造設が可能な方法である．

　Patients with far-advanced esophageal cancer are not eligible for percutaneous endoscopic gastrostomy placement, and the open gastrostomy procedure must be performed. Basic laparoscopic surgery generally involves the use of three ports, a port at the umbilicus for the laparoscopy, in addition to two working ports. As endoscopic surgery techniques improve and minimally invasive surgery becomes more established, the trend is toward using fewer ports. In this case, we describe a laparoscopic method to create a gastrostomy using SILS^TM port as a salvage surgery in a patient with esophageal malignant stricture after definitive chemoradiotheapy for far-advanced esophageal cancer. Laparoscopic gastrostomy using SILS^TM port is a safe and easy method with minimal invasion.