ショック状態の特発性食道破裂に対して腹腔鏡アプローチによる緊急手術を施行し救命しえた1例

A case of spontaneous esophageal rupture in a state of shock treated with emergency laparoscopic surgery

◆要旨：患者は53歳，男性．飲酒後に血性嘔吐を認め救急搬送された．CTと食道造影検査で縦隔内限局型，胸部下部食道左壁の特発性食道破裂と診断した．緊急で腹腔鏡による経裂孔的食道修復術を施行した．穿孔部を3-0 V-Loc^®で全層2層連続縫合し閉鎖した．穿孔部近傍の縦隔内にドレーンを留置し，大網を充塡した．呼吸，循環動態が不安定で挿管呼吸管理のためICUに入室した．ドレナージを要する胸水貯留と軽微な遺残膿瘍を認めたが，縫合不全は認めなかった．一時的に嚥下機能が低下したが，経口摂取可能な状態まで回復し，術後42日目に自宅退院した．ショック状態の特発性食道破裂に対し，腹腔鏡手術で救命しえた1例を経験したので報告する．

　A 53-year-old male presented with hematemesis after alcohol consumption and was brought to the emergency department. CT and esophagography revealed an isolated mediastinal type spontaneous rupture of the left wall of the lower thoracic esophagus. Emergency laparoscopic transhiatal esophageal repair was performed. The perforation site was closed by two-layer continuous suturing with 3-0 V-Loc^®. Drains were placed in the mediastinum near the perforation site, and the omentum was used to reinforce the area. Postoperatively, due to unstable respiratory and circulatory dynamics, he was admitted to the ICU with intubation and respiratory management. Although there was pleural effusion requiring drainage and a minor residual abscess, no suture leakage was observed. Swallowing function temporarily declined, but he recovered to the point of oral intake and was discharged home on postoperative day 42. We report a case of successful laparoscopic surgery for spontaneous esophageal rupture in a shock state.