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高齢など解剖学的血行再建困難症例に対し，非解剖学的血行再建が有用と考えている．対象は，1989年から16年間に施行した非解剖学的血行再建36例（男性33例，女性3例）で，手術時間，術後在院日数，開存率，術後合併症について解剖学的血行再建55例と比較検討した．再建経路は，腋窩─大腿動脈バイパス（18例），大腿─大腿動脈バイパス（18例）であった．手術時間は，解剖学的血行再建に比べ非解剖学的血行再建で有意に短縮されたが，術後在院日数は短縮傾向にとどまった．術前状態不良の1例を除き，重大な術後合併症はなく，5例に遠隔期死亡を認めた．3年後の一次開存率，二次開存率は，大腿─大腿動脈バイパスで，それぞれ88.2±7.9％，94.4±5.4％，腋窩─大腿動脈バイパスでそれぞれ88.9±7.4％，94.1±5.7％であった．非解剖学的血行再建は，高齢者に対する手術侵襲の軽減と生活範囲の拡大や比較的若年者に対しても解剖学的再建が困難な場合は有用と考えられた．

A 49-year-old man was seen at the hospital because he was pointed out having a gastric lesion at a physical examination. A submucosal tumor 1cm in diameter located paracardia was observed with endoscopy. There was no connection between the tumor and the proper muscle layer because the tumor had high mobility within the submucosal layer. We tried an endosopic resection for the gastric lesion 2 weeks later. After the tumor resection, the proper muscle layer was clearly observed in the resected surface, and no bleeding nor perforation was seen. And a pathological study documented us that the tumor was removed with wrapped capsule and without any proper muscle layer component. So we thought that the proper muscule layer had been slightly damaged by the endoscopic procedure. However, he was seen at the hospital again because of perforation of the stomach about 7 hours passed after the endoscope procedure. It is not able to rule out the possibility of delayed perforation of the stomach after the endoscopic procedure, nevertheless the damage of the proper muscle layer would be slight and no immediate perforation would be observed. It is very important to close a mucosal defect by endoscopic procedure with crips or any other goods.

A case of duodenal varices successfully treated by a systemic obliteration of the varices, which has been employed at the department, is reported with a review of the Japanese literature. A 52-year-old woman was admitted to the hospital because of tarry stool. An upper gastrointestinal endoscopy showed an enlarged and tortuous varices with redness in the second portion of the duodenum. Transileocolic vein portgraphy revealed collateral veins composed of the supperior and inferior pancreaticoduodenal veins. From these findings a diagnosis of duodenal varices was made, and a systemic obliteration of varices which composed of an embolization by coils and endoscopic embolization was performed. After that, endoscopical examination revealed that morphology of the varices was improved but the redness persisted. Endoscopic obliteration was carried out two times. No recurrence of the varices has been observed during the follow up period of two years after the treatment. Duodenal varix is rare and the etiology mainly attributable to portal hypertension. It can cause gastrointestinal bleeding. A systemic obliteration of the collateral veins, which has been employed for esophageal varices at the department, was useful.

Leiomyosarcoma of the stomach is a rare disease, and it's main metastatic forms are blood-borne metastasis and peritoneal dissem ination. Thus, the most common metastatic sites are the liver and peritoneum. However, resection of the liver for metastasis of this disease has rarely been reported. We present a patient with leiomyosarcoma of the stomach with liver metastasis who underwent total gastrectomy and liver resection twice for the metastasis. The patient was a 59-year-old woman who was admitted to a hospital associated with out university with gastric leiomyosarcoma and in whom liver metastasis was found in the lateral segment during total gastrectomy. She was readmitted to our clinic and underwent resection of the left lobe of the liver. Subsequently, she again developed a liver metastasis in S8 at 18 months after the resection of the liver and underwent a resection of that segment. Liver metastasis is considered to be an end-stage of cancer and has not been treated positively. However, the case presented here suggests that resection is the most effective treatment for liver metastasis of leiomyosarcoma of the stomach.