Watanabe Megumi, Nagahisa Seiichi, Une Yuta, Kimura Yuji, Taniguchi Fumitaka, Utsumi Masashi, Arata Takashi, Katsuda Ko, Tanakaya Koji, Aoki Hideki
Dept. of Surgery, National Hospital Organization Iwakuni Clinical Center.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2263-2265.
A 67-year-old woman with upper abdominal pain was referred to our hospital. Upper gastrointestinal endoscopy revealed a type 3 gastric cancer at the greater curvature of the angular notch. Abdominal CT helped detect the primary tumor. Multi-detector-row computed tomography(MDCT)and 3D-CT angiography revealed a vascular anomaly in which the left gastric and splenic arteries formed the common trunk. The common hepatic and superior mesenteric arteries formed the common trunk. We performed a laparoscopic distal gastrectomy with D2 lymph node dissection. During suprapancreatic lymph node dissection, the surface of the portal vein was difficult to expose toward the left side because the portal vein joined the splenic and superior mesenteric veins on the caudal side. Therefore, the No. 8a lymph nodes were dissected along the anterior hepatic plexus. In cases of common hepatic artery anomaly, identifying the anterior hepatic plexus is useful for the dissection of the suprapancreatic lymph nodes.
一名67岁上腹部疼痛的女性被转诊至我院。上消化道内镜检查发现角切迹大弯处有3型胃癌。腹部CT有助于检测原发性肿瘤。多排螺旋计算机断层扫描（MDCT）和3D-CT血管造影显示血管异常，即胃左动脉和脾动脉形成共同干。肝总动脉和肠系膜上动脉形成共同干。我们进行了腹腔镜远端胃切除术并清扫D2淋巴结。在胰上淋巴结清扫过程中，由于门静脉在尾侧与脾静脉和肠系膜上静脉汇合，门静脉左侧表面难以暴露。因此，沿肝前丛清扫第8a组淋巴结。在肝总动脉异常的情况下，识别肝前丛有助于胰上淋巴结的清扫。
