縦隔鏡下食道切除術を施行したEMR適応外の早期食道癌の1例

A report of an esophagectomy performed under mediastinal endoscope for EMR-failed early esophageal cancer case

　今回，われわれはEMR適応外の早期食道癌に対して縦隔鏡下食道切除術を行ったので報告する．症例は71歳，男性．下部食道に1／2周強の0—Ⅱc＋Ⅱb，深達度m2の病変を認め，EMRを試みたがlifting不良であり，病変範囲の同定が困難であったため，縦隔鏡下食道切除術を行った．縦隔操作は左頸部の小切開創より行い，両反回神経を良好な視野のもとで確認・温存し，食道を切除した．腹部操作は用手補助下腹腔鏡手術下に行い，胃管を作製し，後縦隔経路による胃管再建を行った．術後経過は良好で，反回神経麻痺などの合併症を認めず安全に施行し得た．本術式はEMR不能食道表在癌に対する根治手術として適応であると思われた．

In this report, we performed esophagectomy of EMR-failed early esophageal cancer under mediastinal endoscope. A 71-year-old man was admitted to our hospital because of early esophageal cancer, which was di-agnosed as lower thoracic squamous cell carcinoma, type 0-Ⅱc+Ⅱb, depth m2, and about half-circle width. Since EMR treatment was unsuccessful due to insufficient lifting of cancer lesion and unclear margin of iodide-non-staining which represents cancerous lesion, we performed esophagectomy under mediastinal endoscope.