胃内手術・内視鏡合同手術にて切除した食道胃接合部GISTの1例

Intragastric surgery and endoscopy cooperative surgery for gastrointestinal stromal tumor at the esophagogastric junction : Report of a case

◆要旨：近年，胃粘膜下腫瘍に対し，腹腔鏡・内視鏡合同手術（LECS）が行われているが，胃後壁大彎側の食道胃接合部GISTは，LECSによる壁欠損部の閉鎖が難しい部位と考えられる．筆者らは術中経口内視鏡と胃内手術を併用して局所切除した症例を経験したので報告する．患者は62歳，男性. 近医の内視鏡にて食道胃接合部後壁大彎側に粘膜下腫瘍を指摘され，精査でGISTの診断となり，手術の方針となった．低侵襲性，機能温存を考慮し，経口内視鏡にて腫瘍周囲の粘膜切開を行った後，胃内手術で腫瘍を切除した．壁欠損部は手縫いで閉鎖した．合併症なく第7病日に退院した．

A 62-year-old man was diagnosed as having a submucosal tumor of the stomach at the posterior and greater curvature of the esophagogastric junction. Cytologic diagnosis under endoscopic ultrasonography was gastrointestinal stromal tumor（GIST）. Taking the minimal invasiveness and preservation of function into consideration, we performed local resection of the stomach using intragastric surgery and endoscopy cooperative surgery. The mucous layer was cut around the tumor using IT knife. The tumor was resected manually with ultrasonic coagulating shears and the defect on the gastric wall was repaired with manual suturing under intragastric surgery. The postoperative course was uneventful and the patient was discharged from the hospital on the 7th day. Intragastric surgery and endoscopy cooperative surgery for the treatment of GIST at the posterior and greater curvature of the esophagogastric junction was performed safely with good operative results.