Behçet病による難治性食道潰瘍に対する胸腔鏡下食道切除術が有用であった1例

Intractable esophageal ulcer due to intestinal Behçet disease successfully treated by thoracoscopic esophagectomy : a case report

◆要旨：患者は38歳，男性．内科的治療で改善を認めず炎症のコントロールが困難であったBehçet病による難治性食道潰瘍に対し，胸腔鏡下食道切除術を行った．内視鏡下手術の低侵襲性が広く認められ，食道癌に対する胸腔鏡下食道切除術が施行されるようになり，手術手技が確立されてきている．本例に対しても胸腔鏡下食道手術手技を応用し，その低侵襲性を活かすことが可能であった．またステロイド投与中であり急性期での一期的な再建を避け，ステロイド離脱後に二期的に再建を行った．本例は，全身状態不良で，かつ高度の炎症を伴った状態での手術であり，低侵襲な胸腔鏡下食道切除術および二期的な再建手術が有用であったと思われたので報告する．

　We herein report a 38-year-old male who was diagnosed as an intractable esophageal ulcer due to Behçet disease. Thoracoscopic surgery for the esophageal ulcer was performed because of uncontrollable severe inflammation which was difficult to control even by steroid and immunosuppressive agents. Since thoracoscopic esophagectomy is minimally invasive, this procedure was selected for the treatment of this patient. Reconstruction of the esophagus was performed as a second-stage operation after terminating steroid administration because of the severe and acute inflammatory state of the esophagus. Two-stage operation consisting of thoracoscopic esophagectomy and subsequent reconstructive procedure is feasible and safe for poor-risk patients with esophageal diseases.