単孔式腹腔鏡下手術を施行しえた食道アカラシア・横隔膜上食道憩室の1例

Single incision laparoscopic surgery for esophageal achalasia with epiphrenic diverticulum

◆要旨：患者は63歳，女性．30代より食道アカラシア，食道憩室症の診断で治療歴がある．今回，通過障害増悪のため手術適応として当科紹介となった．入院時のCT検査で横隔膜上に50mm大の憩室を認め，食道内圧検査では下部食道機能不全と診断された．手術方法として整容性に優れた単孔式腹腔鏡下手術を選択した．臍部創からmultiple trocar法で憩室切除，筋層切開を加え，Heller-Dor手術を施行した．臍部単孔式腹腔鏡下手術は臍からのアプローチで食道長軸方向に沿って自動縫合器を挿入でき，憩室切除，筋層切開，噴門形成も良好な術野で施行可能であった．本疾患は良性疾患であり，摘出臓器も憩室のみで小さいため，単孔式手術の利点を最大限発揮できるものと考えられた．

A 63-year-old woman who had suffered from esophageal achalasia since she was in her 30s was referred to us for surgical treatment of an esophageal diverticulum. Computed tomography performed upon her admission to our hospital revealed a 50-mm diverticulum in the lower esophagus near the diaphragm, and esophageal manometer revealed elevated lower esophageal sphincter pressure. Thus, lower esophageal sphincter dysfunction was diagnosed. We chose to perform single-port laparoscopic surgery because of its cosmetic advantage. We placed an incision at the umbilicus, removed the diverticulum by multi-trocar method, extended the cut made in the muscular layer of the esophagus, and performed a Heller-Dor operation. All procedures were performed through the single umbilical port. An automatic suturing instrument was inserted into the esophagus in the axial direction for the removal of the diverticulum, esophago-cardiomyotomy, and cardioplasty. The esophageal condition in this case was benign and the tissues to be extracted were fairly small, so the disorder proved to be an ideal indication for single incision laparoscopic surgery.