特発性食道破裂に対する胸腔鏡下手術

Thoracoscopic repair of spontaneous esophageal rupture

◆要旨：【目的】特発性食道破裂に対する胸腔鏡下手術の評価．【対象および方法】2002～2009年に当科で胸腔鏡下手術を行った特発性食道破裂5例について臨床的に検討した．【結果】症例は全て男性，平均年齢は54歳で，基礎疾患として慢性腎不全（透析中）が2例に認められた．手術は，破裂部の一期的縫合を胸腔鏡下に4例行った．1例は破裂部が大きく胸腔鏡下食道切除・二期再建とした．一期的縫合した4例は縫合不全を併発しなかった．縦隔・胸腔の洗浄・汚染物の除去は胸腔鏡下に十分施行可能であった．慢性腎不全の2例が長期入院となったが，4例（80％）の症例で予後良好であった．【結論】本疾患に対する胸腔鏡下手術は有用な手技であると考えられた．

We performed thoracoscopic repair for the treatment of spontaneous esophageal rupture. From 2002 to 2009, we experienced 5 cases of esophageal rupture. All patients were male, and average age was 54years. Two patients had chronic kidney disease under hemodialysis. Four patients were treated with primary suture under thoracoscopy. One patient was treated with partial esophagectomy because of wide opening of the ruptured esophagus. No anastomotic leakage was observed in 4 cases treated with primary suture. Irrigation and drainage of mediastinal and thoracic cavities were performed by thoracoscopic procedure in all 5 cases. Although two patients with chronic kidney disease had a longer hospital stay, 80％ of patients had a good prognosis. Thoracoscopic repair is considered to be a very useful method for the treatment of spontaneous esophageal rupture.