腹腔鏡補助下残胃全摘を行ったAdachiⅥ型血管走行異常併存高齢者残胃癌の1例

Laparoscopy-assisted remnant total gastrectomy for gastric cancer with Adachi VI vascular anomaly in a 85-year old patient

◆要旨：患者は85歳，男性．約7年前に当科で早期胃癌（高分化管状腺癌，T1a，N0，H0，P0，Stage IA）に対し幽門側胃切除術，Billroth-I再建を施行した．体重減少を主訴に来院した．上部消化管内視鏡検査で，残胃小彎後壁に2型腫瘍（中分化管状腺癌）を認めた．腹部3D-CTで，Adachi Ⅵ型の総肝動脈走行異常を診断した．85歳と高齢ではあったが，全身状態はperformance status 1と良好で，術前生理機能検査および血液生化学検査はすべて正常範囲内であったため，腹腔鏡補助下残胃全摘術，リンパ節郭清術を施行した．術後合併症はなかった．今回，Adachi Ⅵ型の総肝動脈走行異常を伴った超高齢者残胃癌症例に対し，腹腔鏡補助下残胃全摘術を安全に施行しえた症例を経験したので報告する．

An 85-year-old man was referred to our hospital complaining of weight loss. He had a history of traditional distal gastrectomy with lymphadenectomy after Billroth-I reconstruction for gastric cancer （well differentiated adenocarcinoma, T1a, N0, H0, P0, Stage IA） performed in our hospital 7 years ago. Endoscopic examination revealed an ulcerated tumor with sharply demarcated and raised margins （type 2, moderately differentiated adenocarcinoma） located at the lesser curvature side on the posterior wall of the remnant stomach. 3D-CT showed a vascular anomaly of Type VI in Adachi's classification. In spite of his old age, performance status of the patient was good and the results of preoperative physiological and blood biochemical examinations were within normal range. Laparoscopy-assisted remnant total gastrectomy was performed. Postoperative course was uneventful. We reported a case of gastric remnant carcinoma that was successfully treated by laparoscopy-assisted total gastrectomy, with Adachi type VI vascular anormaly in the elderly patient.