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Stomach and Intestine(Tokyo) Volume 35, Issue 10 （September 2000）

胃と腸 35巻10号（2000年9月発行）

Japanese English

今月の主題食道アカラシア

主題症例

食道アカラシアに合併した広範囲0-Ⅱc型食道癌の1例 Type 0-Ⅱc Early Esophageal Carcinoma Concomitant with Achalasia, Report of a Case 佐伯威男 ¹ , 田辺聡 ¹ , 石井圭太 ² , 朴勝春 ¹ , 小泉和三郎 ¹ , 大井田正人 ¹ , 三橋利温 ¹ , 西元寺克禮 ¹ , 嶋尾仁 ³ , 三富弘之 ⁴ Takeo Saeki ¹ , Satoshi Tanabe ¹ , Keita Ishii ² , Katsuharu Boku ¹ , Katsunori Saigenji ¹ ¹北里大学東病院消化器内科 ²渕野辺総合病院内科 ³北里大学東病院消化器外科 ⁴北里大学東病院病理 ¹Department of Internal Medicine, School of Medicine, Kitasato University ²Department of Internal Medicine, Fuchinobe Hospital キーワード：食道アカラシア , 内視鏡下バルーン拡張術 , 早期食道癌 , 内視鏡的粘膜切除術 , レーザー治療 Keyword: 食道アカラシア , 内視鏡下バルーン拡張術 , 早期食道癌 , 内視鏡的粘膜切除術 , レーザー治療 pp.1293-1297

発行日 2000年9月25日 Published Date 2000/9/25

DOI https://doi.org/10.11477/mf.1403104876

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Abstract 文献概要
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要旨　患者は49歳，男性．19歳時より食事時のつかえ感が出現し，20歳時に他院でアカラシアと診断されたが放置されていた．1994年3月より感冒を契機に食思不振，嘔気嘔吐が増悪し当科受診となった．食道X線検査，内視鏡検査では食道の著明な拡張と下部食道の屈曲および多量の食物残渣の貯溜を認め食道アカラシアと診断した．計4回の内視鏡下バルーン拡張術を施行し，術後の内視鏡検査で切歯列より約25cmに0-Ⅱcを疑う病変を認めた．生検病理組織像で扁平上皮癌と診断され，内視鏡的粘膜切除術を施行した．術後，癌の遺残を認めレーザー治療を併用し有効であった．

　A 49-year-old male had complained of dysphagia for the 30 years preceding admission. In another hospital, he was diagnosed as having esophageal achalasia by upper gastrointestinal barium examination in 1965, but no treatment had been carried out. He was admitted to our hospital in 1994, after having caught a cold. Because of an increase of his complication, such as poor appetite, nausea and vomiting. Esophagogram showed a markedly dilated sigmoid-shaped esophagus with persistent barium retention. Endoscopic balloon dilation therapy was carried out four times for achalasia. After these therapies, endoscopic examination indicated a reddish shallow depressed lesion in the upper esophagus, which was unstained by iodine, and compatible with this lesion as esophageal carcinoma concomitant with achalasia. Squamous cell carcinoma was found in the pathological examination of the endoscopic biopsy specimens from this lesion. Endoscopic mucosal resection (EMR) was performed for the area unstained by iodine. Pathological examination of resected specimens revealed also squamous cell carcinoma in the lamina propia mucosae (m1). After 15 months, follow-up endoscopy was performed and squamous cell carcinoma was found in the pathological examination of endoscopic biopsy specimens from scar lesion. Laser therapy was performed for this lesion. After another two years, an, endoscopic biopsy specimen showed atypical cells. Laser therapy was performed again for the same esophageal lesion. We would like to emphasize the usefulness of EMR and laser therapy for early esophageal carcinoma, and stress the importance of careful long-term follow-up endoscopy for achalasia.