腹腔鏡下噴門形成術が有用であった超高齢者食道裂孔ヘルニアの2例

A report of two extremely elderly cases of esophageal hiatal hernia successfully treated by laparoscopic surgery

◆要旨：［症例1］は嘔吐と誤嚥性肺炎を繰り返している93歳，女性，食道裂孔ヘルニアの診断を受け当科に紹介され入院となった．胃体下部まで胸腔側へ脱出したヘルニアであり，腹腔鏡下噴門形成術を施行した．手術時間は230分，出血は20gであった．［症例2］は93歳，女性で，嘔吐を主訴に近医を受診し，食道裂孔ヘルニアの診断を受けた．保存的加療を行ったが改善せず，当科に紹介され入院となった．胃前庭部まで胸腔側へ脱出しており，腹腔鏡下噴門形成術を施行した．手術時間は135分，出血は少量であった．2例とも術後2日目に食事を開始し，7日目に退院した．術後7か月と13か月が経過し，ともに再発もなく無症状で経過している．早期回復が可能な腹腔鏡下噴門形成術は超高齢者に対しても安全に施行できる有用な術式であると思われる．

　Case 1 : A 93-year-old woman with repeated vomiting and aspiration pneumonia was referred to our hospital and she was diagnosed as esophageal hiatal hernia. For this hernia, we successfully performed a laparoscopic fundoplication. The operation time was 230 minutes and the amount of bleeding was 20 g.

　Case 2 : A 93-year-old woman with esophageal hiatal hernia failed in conservative treatment for vomiting and she underwent a laparoscopic fundoplication in our hospital. The operation time was 135 minutes and the amount of bleeding was minimal.

　Although the two patients were extremely elderly, their postoperative courses were uneventful. Both patients had no symptoms and no recurrence during 7 months for one patient and 13 months for the other after surgery. Laparoscopic fundoplication is considered to be an useful and safe treatment for esophageal hiatal hernia even for extremely elderly patients.