食道切除術後の胃管気管瘻に対し右胸鎖乳突筋弁を用いて胸腔鏡下に気管瘻孔部修復を施行した1例

Thoracoscopic tracheal repair using a right sternocleidomastoid flap for fistula formation between trachea and esophagogastric anastomosis after esophagectomy for esophageal cancer : A case report

◆要旨：食道切除術後の胃管気管瘻に対し，右胸鎖乳突筋弁を用いて胸腔鏡下に気管瘻孔部修復を施行した1例を経験した．患者は55歳男性．胸部中部食道癌，cT3N2M0, StageⅢに対し，術前FP療法後に腹臥位胸腔鏡下食道亜全摘，後縦隔経路頸部胃管再建術を施行した．術後13日目に胃管気管瘻をきたし，再手術を施行した．頸部操作で胃管気管瘻を開放し食道瘻を造設，頭側を茎とする右胸鎖乳突筋弁を作成した．気管膜様部欠損孔は腹臥位胸腔鏡下に胸鎖乳突筋弁で被覆した．患者は合併症なく回復し，再手術後44日目に胃管および遊離空腸を用いた再々建術を施行した．頸胸境界部の胃管気管瘻に対して胸鎖乳突筋弁による修復術は有用と考えられた．

　We report a case of thoracoscopic tracheal repair using a right sternocleidomastoid （SCM） flap for fistula formation between trachea and esophagogastric anastomosis after esophagectomy. A 55-year-old man underwent a thoracoscopic esophagectomy with posterior mediastinal gastric conduit reconstruction for stageⅢ middle esophageal cancer. On post-operative day 13, gastro-tracheal fistula was diagnosed, and a reoperation was performed. We released the fistula and created a right SCM flap and an esophagostomy by cervical approach. The fistula was repaired using the SCM flap under thoracoscopy in the prone position. The patient recovered uneventfully and re-reconstruction using the gastric conduit and a free jejunal graft was performed 51 days later. A repair using SCM flap would be an effective option for gastro-tracheal fistula after esophagectomy.