頚椎脊索腫摘出・プレート併用前方再建術後食道穿孔を来した1例

Esophageal Perforation Occurring after Resection of Cervical Spinal Chordoma and Spinal Reconstruction with Anterior Plate Fixation : Case Report

　抄録：頚椎に発生した脊索腫に対し腫瘍摘出・プレート併用前方固定術を施行後，遅発性に食道穿孔を認めた症例を経験した．症例は47歳，女性．第4-6頚椎の脊索腫に対し，腫瘍摘出および前方プレートを併用した第3-7頚椎前方固定術を施行した．術後早期よりプレートの緩みを認めたが，患者の都合もあり術後3年で抜釘を行った．抜釘術前には嚥下障害などの自覚症状は全くなかったが，全身麻酔の挿管時に食道後方に金属塊が発見されたため食道穿孔と診断し，プレート抜去・食道皮膚剪造設を行い，術後8週で穿孔部の閉鎖を確認し同剪閉鎖術を施行した．術後1年の現在，食道剪の再発は認めていない．本例のような遅発性食道穿孔は極めて稀と考えられるが，プレート固定例では念頭に置いておくべき合併症の1つと思われた．

　We report a case of late onset esophageal perforation after anterior tumor resection and reconstruction of the cervical spine using an anterior cervical plate. A 47-year-old woman underwent resection of cervical spinal chordoma followed by spinal reconstruction using an anterior plate.

　Shortly after surgery, X-ray radiography showed the plate has loosened, although the patient had no local or general symptoms. Removal of the plate was delayed until three years after surgery. At intratracheal intubation, the plate was found through a defect in the posterior wall of the esophagus by the anesthesiologist, immediately removed, and an esophagus-skin fistula constructed by a laryngologist. The fistula was closed successfully 6 weeks later, and she has had no sign of esophageal fistula or tumor recurrence in the one year since the second surgery.

　Late-onset esophageal perforation, although rare, can occur especially if the patient has loosening of an anterior cervical plate.