食道静脈瘤合併胸部食道癌における内視鏡下手術手技の工夫—腹部操作先行・脾摘付加が胸部操作時の出血抑制に有効と考えられた2例

Two cases of esophageal carcinoma with esophageal varices treated by video-assisted thoracoscopic esophagectomy following hand-assisted laparoscopic gastric conduit creation combined with devascularization and splenectomy

◆要旨：食道静脈瘤を合併する食道癌に対して腹部操作先行にて脾摘を付加することで安全に胸腔鏡下食道切除術を施行しえた2例を経験した．食道静脈瘤合併食道癌に対する手術においては，静脈瘤ならびに肝硬変によるに血小板減少・凝固能低下のため，食道周囲の剝離操作や胃管作製に際して多量の出血が危惧される．そこで筆者らは腹部操作を腹腔鏡下に先行して食道周囲の血行郭清ならびに食道切離を行うことで，胸部操作での出血を最小限に抑える工夫を行っている．本術式は食道静脈瘤を伴う肝硬変を合併する食道癌症例に対する有用な術式と考えられた．

　We report two cases of esophageal carcinoma with esophageal varices treated by video-assisted thoracoscopic esophagectomy following hand-assisted laparoscopic gastric conduit creation combined with devascularization and splenectomy. Surgical treatment of esophageal carcinoma with esophageal varices is technically difficult in patients with hepatic cirrhosis because of the risk of massive hemorrhage caused by hemorrhagic esophageal varices, as well as the subsequent thrombocytopenia and coagulopathy. The initial devascularization of the upper part of the stomach and the magnifying effect of laparoscopic surgery decreases bleeding, making this procedure useful in patients with hepatic cirrhosis.