左胃動脈から総肝動脈が分岐する稀な破格を認めた早期胃癌患者に腹腔鏡下幽門側胃切除術を施行した1例

A case of laparoscopic distal gastrectomy in a patient with the common hepatic artery diverging from the left gastric artery

◆要旨：左胃動脈から総肝動脈が分岐する稀な破格を認めた早期胃癌患者に腹腔鏡下幽門側胃切除術を施行したので報告する．患者は76歳，女性．胃体中部小彎の0-IIa＋IIc病変．深達度SMの早期胃癌．術前の腹部CTで腹腔動脈は通常分岐と思われたが，術中所見では膵上縁に総肝動脈を認めず破格が判明した．さらに小網内に肝に向かい走行する太い血管を認め，左副肝動脈と考え左胃動脈根部で切離したが，後に左胃動脈から総肝動脈が分岐する足立6型26群と判明した．当症例は総肝動脈切離後も肝血流は十分保たれたが，稀な血管破格をも十分熟知することにより，重要な血管を温存し，より安全な手術が可能となると考えた．

A 76-year-old female who had a vascular anomaly where the common hepatic artery diverging from the left gastric artery, underwent laparoscopic distal gastrectomy for a submucosal gastric cancer located in the lesser curvature of the middle third of the stomach. Vascular anomaly was not found in preoperative assessment by enhanced CT. However, lack of common hepatic artery in the superior border of the pancreas was detected intraoperatively, so vascular anomaly was suspected. A large artery within the lesser omentum was also detected but we initially thought this artery was an accessory left hepatic artery and it was divided. Finally, Adachi type 6 group 26 vascular anomaly where the common hepatic artery diverges from the left gastric artery was revealed. Though hepatic blood flow was kept in our case, we thought that we could perform safer laparoscopic gastrectomy without dividing common hepatic artery if we were familiar with this rare vascular anomaly.