胃噴門部粘膜下腫瘍に対する手縫いを駆使した単孔式胃内手術の手術成績

Technique and operative results of single incision percutaneous endoscopic intragastric surgery for submucosal tumor at esophagogastric junction

◆要旨：【目的】48例の胃噴門部粘膜下腫瘍に対して単孔式胃内手術を施行し，手術成績を検討した．【方法】臍部に胃瘻を作製しマルチチャンネルポートを挿入して，左季肋部から2mmの鉗子を胃内に挿入した．自動縫合器は使用せず胃内腔から腫瘍を切除し，胃壁の欠損部を手縫いで閉鎖した．【結果】平均手術時間は138.7分で，術式の移行はなかった．術後合併症は腹腔内膿瘍を1例（2.1％）に認めたが保存的に治癒した．病理所見では全例で切除断端は陰性であった．平均在院日数は7.9日で，全例で良好な整容性が得られた．【結論】胃噴門部粘膜下腫瘍に対する単孔式胃内手術は，適応を選び腹腔鏡下縫合技術に習熟すれば安全に行うことができる．

【Background】Single incision percutaneous endoscopic intragastric surgery（SIPEIGS） was performed on 48 patients with submucosal tumor at the esophagogastric junction. The surgical technique and operative results are herein reported.【Methods】 A multichannel port, x-Gate^Ⓡ, was inserted in the stomach through a temporal gastrostoma established at the navel. A 2mm grasper, BJ Needle^Ⓡ, was inserted in the stomach through a 2mm trocar at the left subcostal area. The tumor was resected manually without using the staplers and the defect on the gastric wall was repaired with manual suturing. 【Results】The average operation time was 138.7 minutes, and there was no conversion to conventional surgery. There was one（2.1％） localized pertionitis postoperatively which was cured with antibiotics. Pathological results showed negative margins in all patients. The average postoperative hospital stay was 7.9 days and the cosmetic result seemed excellent. 【Conclusion】SIPEIGS in the treatment of submucosal tumor at the esophagogastric junction may be performed safely with good operative results by surgeons with manual suturing skill.