胸腔鏡下憩室切除術を施行した横隔膜上食道憩室の1例

A case of thoracoscopic diverticulectomy for epiphrenic esophageal diverticulum

◆要旨：患者は65歳，男性．嚥下障害を主訴に当院を受診し，精査の結果，横隔膜上食道憩室と診断された．保存的治療で改善が得られず，手術目的で当科に紹介となった．胸部単純CTで胸部下部食道の左壁に5×4cm大の憩室を認めた．上部消化管内視鏡で憩室の粘膜に炎症性変化を認めたが，胃食道逆流を疑うような食道粘膜傷害を認めなかった．また食道内圧検査にて下部食道括約筋圧の異常を認めなかった．胸腔鏡下憩室切除術を施行し，術後経過は良好であった．横隔膜上食道憩室に対する術式については一定の見解が得られていないが，自験例のような症例は胸腔鏡下憩室切除術の良い適応である可能性が示唆されたため，文献的考察を含めて報告する．

　A 65-year-old man presented with dysphagia and was diagnosed with an epiphrenic esophageal diverticulum. Chest CT showed a 5×4 cm diverticulum in the left wall of the lower esophagus. Esophagoscopy showed mucosal inflammation in the diverticulum, but there were no findings of esophagitis caused by gastroesophageal reflux. A hypertensive lower esophageal sphincter was not detected by esophageal manometry. Thoracoscopic diverticulectomy was performed, and postoperative course was good. The use of a surgical procedure to treat epiphrenic esophageal diverticulum is controversial ; however, thoracoscopic diverticulectomy has been suggested to be a better treatment for epiphrenic esophageal diverticulum without esophageal motility disorder, hypertensive lower esophageal sphincter or gastroesophageal reflux.