洗剤誤飲長期経過後に難治性食道狭窄をきたした腐食性食道炎に対し腹腔鏡・胸腔鏡下に切除再建術を行った1例

Corrosive esophagitis occurring 5 years after sodium hypochlorite ingestion and treated by video-assisted Ivor Lewis esophagectomy in prone position

◆要旨：患者は62歳，男性．自殺企図によるアルカリ性製剤の服用歴があった．服用5年後に通過障害の訴えで当院を受診し，内視鏡検査で食道狭窄を認めた．バルーン拡張術を1年以上にわたり行ったものの改善が認められず，腹腔鏡・胸腔鏡下での食道切除術・胃管再建術を行い，術後44日目に退院した．手術は仰臥位からの腹腔鏡操作による胃管作製を先行させ，その後胸腔鏡による食道切除・胃管吻合を行うことで手術の簡略化を図った．今回腹腔鏡・胸腔鏡下および胸腔内吻合での腐食性食道狭窄に対する症例を経験したので報告する．

　We report the case of a 62-year-old man who drank alkaline detergent in a suicide attempt. Five years later, he consulted our hospital for a swallowing disorder. Esophagogastroduodenoscopy revealed esophageal stenosis; thus, we performed balloon dilatation several times over the next 15 months. However, the stenosis was not alleviated. Video-assisted esophagectomy was then performed, and the patient was eventually discharged from the hospital on the 44th postoperative day. We used laparoscopic approaches before using a thoracoscopic esophagectomy to simplify the procedure and performed intrathoracic anastomosis of esophagogastrostomy for minimally invasive surgery.