胸腔鏡および頸部切開にて核出しえた頸胸境界部食道神経鞘腫の1例

Thoracoscopy-assisted enucleation of schwannoma of the cervicothoracic esophagus : report of a case

◆要旨：頸胸境界部の食道神経鞘腫を胸腔鏡および頸部切開操作の併用にて低侵襲に核出しえた症例を経験したので報告する．患者は74歳，女性．嚥下困難感にて上部消化管内視鏡検査を施行し，5cm大の頸胸境界部食道粘膜下腫瘍と診断された．術前のEUS-FNABにて神経鞘腫が疑われた．胸腔鏡下に食道を授動した後，頸部創から食道を牽引し腫瘍核出術を施行した．術後経過は良好で合併症はなく，術後2年現在再発の所見はない．良性食道粘膜下腫瘍は胸腔鏡下核出術が標準治療となりつつあるが，頸胸境界部病変は大きさや周在性により胸骨縦切開や食道切除が必要となることもある．本術式は頸胸境界部食道粘膜下腫瘍に対する低侵襲なアプローチとして有用であると考えられる．

We report a case in which an enucleation of an esophageal schwannoma at the cervicothoracic area was performed minimal-invasively by thoracoscopy and cervical manipulation. Upper gastrointestinal endoscopy found an esophageal submucosal tumor in a 74 year-old woman complaining of dysphagia. It was located at the cervicothoracic region, measuring 5cm in length. Endoscopic ultrasound guided fine needle aspiration biopsy revealed schwannoma. Upper two thirds of the thoracic esophagus was mobilized thoracoscopically, and then the tumor was enucleated from the esophagus which was pulled out through the cervical incision. The postoperative course was uneventful and no recurrence has occurred in the 24 months following surgery. Thoracoscopic enucleation is becoming standard treatment for the benign esophageal submucosal tumor, but such tumor located at cervicothoracic area sometimes necessitates median sternotomy or esophagectomy for its removal. We conclude that the combination of thoracoscopy and cervical approach is one of the useful options for the treatment of the submucosal tumor at the cervicothoracic region.