術後心タンポナーデをきたした食道癌の1例

A case of esophageal cancer with postoperative cardiac tamponade

◆要旨：症例は51歳，男性．食道癌の診断で，胸腔鏡腹腔鏡下胸部食道亜全摘術，胸骨後経路胃管再建を施行した．手術翌日に冷汗，血圧低下が出現，CT検査で心囊液貯留を認め心タンポナーデと診断した．胸骨後経路再建後のため剣状突起下経皮的ドレナージを行えず，緊急で胸腔鏡下心囊開窓術を施行した．心囊は緊満し，心膜を切開すると470mlの血液の流出を認めた．2箇所心囊開窓を施行し，胸腔ドレーンを留置し手術を終了した．術後経過は良好で心囊開窓術より20日後に退院となった．

　食道癌術後の心タンポナーデはきわめて稀だが発見が遅れると致死的となり，早期のドレナージを要する．胸骨後経路再建の場合，循環動態が許せば胸腔鏡下心囊開窓術は有効である．

　A 51-year-old man diagnosed with esophageal cancer underwent thoracoscopic and laparoscopic subtotal thoracic esophagectomy, 3-regional dissection, and retrosternal route gastric tube reconstruction. The day after the operation, cold sweat, hypotension, and bradycardia were observed. Contrast-enhanced CT examination revealed accumulation of pericardial fluid, and a diagnosis of cardiac tamponade was made. Due to the gastric tube running in the retrosternal route, percutaneous drainage from the caudal side of the xiphoid process could not be performed. Therefore, emergency thoracoscopic cardiotomy was performed. The cardiac sac was tense and bloody fluid （volume: 470 ml） was drained by pericardial fenestration. After making one more incision on the sac, the surgery was finished with the placement of a chest tube. The postoperative course was uneventful, and the patient was discharged on the 20th days after the second surgery.

　Cardiac tamponade after esophageal cancer surgery is extremely rare but it can lead to a fatal condition, especially in cases with a delayed diagnosis. In the case of retrosternal pathway reconstruction, thoracoscopic cardiotomy is effective under sufficient hemodynamic condition.