酸性物質による腐食性胃炎後の噴門・幽門狭窄に対して腹腔鏡補助下胃全摘を施行した1例

A case of laparoscopy-assisted total gastrectomy for a patient with a stricture of the stomach following corrosive ingestion

◆要旨：腐食性胃炎は酸やアルカリなど組織障害性の強い腐食剤の飲用により生じる．急性期では穿孔・腹膜炎，大量出血時に緊急手術の適応となり，慢性期では瘢痕による通過障害が手術適応となりうる．腐食性胃炎後に噴門・幽門狭窄をきたし，腹腔鏡補助下胃全摘術を施行した症例を報告する．患者は75歳女性で，自殺目的にトイレ用洗浄剤を飲用し，救急搬送された．3か月間保存的治療が行われたが，幽門および噴門狭窄となり手術を選択した．5ポート，気腹法，5cmの小切開にて腹腔鏡補助下胃全摘，Roux-en Y再建を行った．術後経過良好で，第27病日に精神科病院に転院した． 本術式は腐食性胃炎に対しては安全で有効な手術術式である．

　Corrosive gastritis is an acute inflammatory condition of the stomach caused by the ingestion of an acid, alkali, or other corrosive chemical. Surgical treatment is necessary for perforation, peritonitis, and massive bleeding in the acute phase or for obstruction caused by scarring in the late phase. We report a case of successful treatment by laparoscopy-assisted total gastrectomy （LATG） of a patient with severe strictures caused by corrosive gastritis. A 75-year-old woman attempted suicide by ingesting hydrochloric acid. Severe gastritis and esophagitis was identified by upper gastrointestinal endoscopy. Her oral intake did not improve after three months of conservative therapy including total parental nutrition because of a diffuse stricture from the cardiac region to the pylorus. LATG with Roux-en Y reconstruction was performed using 5 ports, mini-laparotomy with a 5 cm wound, and pneumoperitoneum. The postoperative course was uneventful and she changed hospitals to undergo treatment of her psychiatric disease 27 days after surgery. This case demonstrates that laparoscopic resection and reconstruction may be a safe and useful technique for patients with corrosive injuries.