内視鏡を用いたomental patch methodにて胃管を温存し救命しえた胸腔鏡下食道切除後胃管穿孔の1例

A case of gastric tube perforation following esophagectomy for esophageal cancer successfully treated by endoscopic omental patch method with gastric tube conservation

◆要旨：患者は70歳，男性．腹部食道癌に対して胸腔鏡下食道亜全摘，胸骨後胃管再建，頸部吻合を施行した．第2病日に右胸腔ドレーンより腸液色の排液を認め，CT，上部消化管透視にて胃管穿孔と診断し，再手術を行った．頸部吻合より肛門側約10cmに胃管穿孔を認めた．胃管切除は手術侵襲が大きいと判断し，消化管内視鏡の先端を穿孔部へ通し，把持鉗子を腹腔内に進め，大網を把持して胃管内まで吊上げ，クリップにて胃壁に固定した．再手術後，ドレーン排液量は漸減し，穿孔部は再生組織に覆われた．食道癌術後胃管穿孔に対して胃管切除が選択できない場合，穿孔部の大網被覆と穿孔部周囲のドレナージは有効な場合もあると考えられたため，若干の考察を加えて報告する．

　A 70-year-old man underwent retrosternal gastric tube reconstruction following subtotal esophagectomy for advanced abdominal esophageal cancer. On the second post-operative day, drained fluid changed to intestinal juice. Computed tomography and gastrointestinal fluoroscopy showed perforation of the gastric tube. We then performed emergency surgery, and laparotomy was redone. During surgery, gastrointestinal endoscopy demonstrated gastric tube perforation at 10 cm from the anastomosis of stomach to cervical esophagus. It was too invasive to perform the resection of gastric tube, so we pulled the greater omentum into the stomach through the perforation site and fastened with clips （omental patch method）. The drainage then gradually decreased, and the perforation healed with regenerating epithelium. The omental patch method and drainage proved useful to treat gastric tube perforation following esophagectomy, and should be considered if resection of the gastric tube is difficult.