内容紹介
Summary
We describe a case of residual stomach preserving surgery performed under evaluation of residual gastric blood flow with indocyanine green(ICG)fluorography, for gastric cancer with recurrence of splenic lymph node metastasis after distal gastrectomy(DG)in a 65-year-old man. After 4 courses of S-1 plus CDDP(SP)therapy for advanced gastric cancer with ascites, DG, D2 dissection, and BillrothⅠ reconstruction were performed and radical resection was obtained(L, Type 3, pap/tub, ypT3N1H0P0CY0M0, ypStageⅡB). Three years and 6 months after the surgery, a mass 4 cm in diameter was found in the splenic hilum, and a pancreatosplenial resection was performed to remove the tumor for diagnosis and treatment purposes. We confirmed that there was no problem with blood flow, and we were able to preserve the stomach. Intraoperative ICG fluorescence imaging was considered a promising method for evaluating residual gastric blood flow.
要旨
症例は65歳,男性。腹水を認めた進行胃癌に対しS-1+CDDP(SP)療法を4コース施行後,幽門側胃切除(DG),D2郭清,BillrothⅠ法再建を行い根治切除を得た(L,Type 3,pap/tub,ypT3N1H0P0CY0M0,ypStageⅡB)。術後3年6か月目,脾門部に径4 cmの腫瘍を認め,診断・治療目的に腫瘍切除を予定した。手術: 腫瘍摘出に膵尾部脾臓合併切除が必要と判断し,術中に脾動静脈の遮断下にインドシアニングリーン(indocyanine green: ICG)蛍光造影にて残胃血流を確認し,残胃を温存して膵尾部脾臓合併腫瘍切除を行った。術後経過は良好で第12病日に退院した。病理組織学的診断は胃癌脾門部リンパ節転移で,術後6か月現在,無再発経過観察中である。結語: 胃癌DG後の脾門部リンパ節再発への手術に際して,術中ICG蛍光造影を行い残胃温存の可否を評価した1例を経験した。ICG蛍光造影は残胃温存の評価に有効な診断方法である。
目次
We describe a case of residual stomach preserving surgery performed under evaluation of residual gastric blood flow with indocyanine green(ICG)fluorography, for gastric cancer with recurrence of splenic lymph node metastasis after distal gastrectomy(DG)in a 65-year-old man. After 4 courses of S-1 plus CDDP(SP)therapy for advanced gastric cancer with ascites, DG, D2 dissection, and BillrothⅠ reconstruction were performed and radical resection was obtained(L, Type 3, pap/tub, ypT3N1H0P0CY0M0, ypStageⅡB). Three years and 6 months after the surgery, a mass 4 cm in diameter was found in the splenic hilum, and a pancreatosplenial resection was performed to remove the tumor for diagnosis and treatment purposes. We confirmed that there was no problem with blood flow, and we were able to preserve the stomach. Intraoperative ICG fluorescence imaging was considered a promising method for evaluating residual gastric blood flow.
要旨
症例は65歳,男性。腹水を認めた進行胃癌に対しS-1+CDDP(SP)療法を4コース施行後,幽門側胃切除(DG),D2郭清,BillrothⅠ法再建を行い根治切除を得た(L,Type 3,pap/tub,ypT3N1H0P0CY0M0,ypStageⅡB)。術後3年6か月目,脾門部に径4 cmの腫瘍を認め,診断・治療目的に腫瘍切除を予定した。手術: 腫瘍摘出に膵尾部脾臓合併切除が必要と判断し,術中に脾動静脈の遮断下にインドシアニングリーン(indocyanine green: ICG)蛍光造影にて残胃血流を確認し,残胃を温存して膵尾部脾臓合併腫瘍切除を行った。術後経過は良好で第12病日に退院した。病理組織学的診断は胃癌脾門部リンパ節転移で,術後6か月現在,無再発経過観察中である。結語: 胃癌DG後の脾門部リンパ節再発への手術に際して,術中ICG蛍光造影を行い残胃温存の可否を評価した1例を経験した。ICG蛍光造影は残胃温存の評価に有効な診断方法である。