肝胃動脈幹を有する胃癌に対して腹腔鏡下胃全摘術を施行した1例

A case of laparoscopic total gastrectomy in a patient with gastric cancer with a hepato-gastric trunk

◆要旨：Adachi分類に該当しない肝胃動脈幹を有する破格を術前のMDCTにて診断し，腹腔鏡下胃全摘術を施行した胃癌の1例を報告する．患者は64歳，女性．検診にて体上部小彎に胃癌を指摘され，手術目的に紹介され受診した．術前MDCTでは，腹腔動脈は存在せず肝胃動脈幹，脾動脈，上腸間膜動脈が腹部大動脈からそれぞれ直接分枝していた．肝胃動脈幹は小網内を上行して左胃動脈を2本分枝した後，小網付着部に沿って下行し左右肝動脈を分枝していた．術中所見も同様で，膵上縁の総肝動脈は欠損していた．特殊な破格であってもMDCTによる3D血管構築を用いた術前の詳細な画像診断により，肝血流を温存した確実なリンパ節郭清が可能であった．

　We report a case of early gastric cancer with a rare vascular anomaly of the hepato-gastric trunk, which can not be categorized by the Adachi classification system. A 64-year-old woman was referred to our hospital for gastric cancer treatment. Endoscopic examination revealed a 2-cm 0-IIc lesion in the lessor curvature of the upper gastric body. Preoperative multidetector row computed tomography showed the absence of the celiac artery, and the hepato-gastric trunk, splenic artery and supramesenteric artery were found to independently originate from the abdominal aorta. The hepato-gastric trunk ran upward and gave off the two left gastric arteries. Thereafter the hepato-gastric trunk passed downward along the attachment of the lessor omentum and gave off the left and right hepatic arteries. The common hepatic artery was not detectable at the superior border of the pancreas. 3D angiographic findings were identical to the intraoperative findings. Despite unusual patterns of vessel branching, preoperative diagnosis of the precise vascular anatomy could enable adequate lymph node dissection, thus maintaining blood flow to the liver.