巨大横隔膜上憩室を伴った食道アカラシアに対し腹腔鏡下手術を施行した1例

A case of esophageal achalasia with giant epiphrenic diverticulum treated by laparoscopic surgery

◆要旨：患者は43歳，女性．2010年よりつかえ感を自覚していた．近医を受診し逆流性食道炎の診断で内服治療を続けたが改善しなかった．2011年に施行された上部消化管内視鏡検査で食道憩室を指摘され当科紹介となった．食道X線造影検査で噴門部から3cm口側に50mm大の憩室と口側食道の横径30mmの拡張およびバリウムの排出遅延を認め，巨大横隔膜上憩室を伴った食道アカラシアの診断で手術となった．腹腔鏡下に食道憩室を腹腔内に引き出し自動縫合器で食道長軸方向に切除した後に，食道アカラシアに対してはHeller-Dor法を行った．特に問題なく術後7日目に退院した．退院後早期に1度内視鏡的拡張術を施行したが，その後24か月再発なく経過良好である．巨大横隔膜上憩室を伴った食道アカラシアの腹腔鏡下手術報告例は少ない．文献的考察を含めて報告する．

　A 43-year-old female had been aware of a feeling of something stuck in her throat since 2010. She visited a local hospital, was diagnosed with reflux esophagitis, and treated by oral drug administration, but showed no improvement. In 2011, upper gastrointestinal endoscopy revealed an esophageal diverticulum, and she was referred to our hospital. Esophagography showed a diverticulum（50mm） 3 cm oral to the cardia, dilation of the oral side esophagus（transverse axis, 30mm）, and delayed barium excretion. A diagnosis of esophageal achalasia with a large epiphrenic diverticulum was made, and surgery was planned. Under laparoscopy, the esophageal diverticulum was pulled into the abdominal cavity and resected in the esophageal long-axis direction using an automatic suturing device. Subsequently, the Heller-Dor technique was performed for the esophageal achalasia. She was uneventfully discharged 7 days after the operation. She received pneumatic dilation only once, but up until the present, no recurrence has been observed for 24 months after the operation. There have been only a few reported cases of esophageal achalasia with a large epiphrenic diverticulum treated by laparoscopic surgery. This case is reported with a review of the literature.