食道癌を合併した食道および胃重複症の1治験例

Duplication of the Esophagus and Stomach with Esophageal Cancer

　消化管重複症の報告は近年わが国においても増加しており，それほど珍しくはなくなったが，それらの多くは小腸および大腸の重複症であり，食道および胃の重複症はまだ稀である．またそれらは囊腫状で消化管と交通のない場合が多く，消化管と交通を持ち，相接する腸管と似た管状の重複症は比較的稀であり，記載の明らかな本邦の食道重複症報告例は現在まで30例であるが，管状重複症はその内の3例に過ぎない．

　著者は先年，成人の大きな管状胃重複症の治験例を報告したが²⁸⁾，本例はその後の経過観察中に食道癌に罹患し，その根治手術に際して，癌を有する本来の食道の全長にわたり，これと接して走る，完全に近い重複食道を認め，これも摘除，治癒せしめえたので，若干の文献的考察を加えて報告する．

　A 50 year-old housewife having two duplications of the esophagus and stomach associated with esophageal cancer is reported.

　Three years ago, she was operated upon for a tubular duplication of the stomach which was 33 cm in length and had multiple ulcers. About thirty months later, she started to have burning sensation on the throat without dysphagia. X-ray and endoscopic examinations revealed the presence of esophageal cancer at the middle thoracic esophagus. At the time of esophageal resection, a complete duplication of the esophagus along the true esophagus with the cancerous lesion was observed. It was extending from the posterior wall of the fundus where it communicated with the stomach to the region of the retropharynx, terminating there as a slender blind tube. The duplication was 22cm in length.

　The esophageal cancer was resected radically as usual: total resection of the thoracic esophagus and anastomosis of the cervical esophagus to the stomach which was replaced through the retrosternal space. Concomitantly, the duplicated esophagus and the two spleens of the same size were also totally excised. Microscopic findings demonstrated the squamous cell cancer was confined to the muscle layer of the esophagus, 4 by 2cm in size, and involved no lymph nodes.

　At the upper part of the duplication, it was slender and thin with no muscle layer, but in middle or lower part, it thickened gradually and showed the almost normal appearance and structure of the esophagus.

　Her postoperative course was uneventful and she has been well 2 years after surgery.