内容紹介
Summary
A 32-year-old woman with a history of undergoing upper gastrointestinal surgery was administered prednisolone for abortive Behçet's disease since 2015. In March 2017, upper gastrointestinal endoscopy revealed a 0-Ⅱc type early stage gastric carcinoma at the posterior wall of the gastric antrum. The pathological diagnosis was signet-ring cell carcinoma. This gastric carcinoma was classified as cT1aN0M0; therefore, endoscopic submucosal dissection(ESD)was performed for the expanded indication lesion in April 2017. The pathological diagnosis after ESD indicated the need for non-curative resection; thus, laparoscopy-assisted distal gastrectomy and BillrothⅠ anastomosis were performed in July 2017. A transient anastomotic structure was admitted after this surgery, but she was discharged from the hospital lighthearted. A preoperative important aspect was the careful examination of all intestinal tracts for ulcer lesions, and an intraoperative important aspect was hand-sewn anastomosis because using a metallic stapler conferred a high risk of ulcer lesions and suture failure. We encountered a case wherein laparoscopy-assisted distal gastrectomy was performed in a patient with abortive Behçet's disease, early stage gastric carcinoma, and a history of undergoing upper gastrointestinal surgery.
要旨
症例は32歳,女性。上部消化管穿孔術後,2015年から不全型ベーチェット病の診断でプレドニゾロンを内服中であった。2017年3月,穿孔後経過観察中の上部消化管内視鏡で胃前庭部大弯後壁に径15 mmの0-Ⅱc病変を認め,生検で印環細胞癌が検出された。胃癌,cT1aN0M0の診断で,適応拡大病変として4月に内視鏡的粘膜下層剝離術(ESD)を施行した。病理結果で粘膜下層への浸潤を認め非治癒切除であったため,6月に追加切除として腹腔鏡下幽門側胃切除(D1+郭清)およびBillrothⅠ再建を施行した。本症例の術前の留意点としては,カプセル内視鏡検査を含め全腸管の潰瘍病変の検索を行ったこと,術中の留意点としては金属ステープラーによる器械刺激で潰瘍形成や縫合不全のリスクが高くなるため再建を手縫い吻合で行ったことである。
目次
A 32-year-old woman with a history of undergoing upper gastrointestinal surgery was administered prednisolone for abortive Behçet's disease since 2015. In March 2017, upper gastrointestinal endoscopy revealed a 0-Ⅱc type early stage gastric carcinoma at the posterior wall of the gastric antrum. The pathological diagnosis was signet-ring cell carcinoma. This gastric carcinoma was classified as cT1aN0M0; therefore, endoscopic submucosal dissection(ESD)was performed for the expanded indication lesion in April 2017. The pathological diagnosis after ESD indicated the need for non-curative resection; thus, laparoscopy-assisted distal gastrectomy and BillrothⅠ anastomosis were performed in July 2017. A transient anastomotic structure was admitted after this surgery, but she was discharged from the hospital lighthearted. A preoperative important aspect was the careful examination of all intestinal tracts for ulcer lesions, and an intraoperative important aspect was hand-sewn anastomosis because using a metallic stapler conferred a high risk of ulcer lesions and suture failure. We encountered a case wherein laparoscopy-assisted distal gastrectomy was performed in a patient with abortive Behçet's disease, early stage gastric carcinoma, and a history of undergoing upper gastrointestinal surgery.
要旨
症例は32歳,女性。上部消化管穿孔術後,2015年から不全型ベーチェット病の診断でプレドニゾロンを内服中であった。2017年3月,穿孔後経過観察中の上部消化管内視鏡で胃前庭部大弯後壁に径15 mmの0-Ⅱc病変を認め,生検で印環細胞癌が検出された。胃癌,cT1aN0M0の診断で,適応拡大病変として4月に内視鏡的粘膜下層剝離術(ESD)を施行した。病理結果で粘膜下層への浸潤を認め非治癒切除であったため,6月に追加切除として腹腔鏡下幽門側胃切除(D1+郭清)およびBillrothⅠ再建を施行した。本症例の術前の留意点としては,カプセル内視鏡検査を含め全腸管の潰瘍病変の検索を行ったこと,術中の留意点としては金属ステープラーによる器械刺激で潰瘍形成や縫合不全のリスクが高くなるため再建を手縫い吻合で行ったことである。