開窓と塩基性線維芽細胞成長因子製剤により自然閉鎖しえた膿胸を伴う特発性食道破裂

Successful Treatment of Spontaneous Esophageal Rupture with Empyema by the Open Drainage and Application of Basic Fibroblast Growth Factor

特発性食道破裂は早期に重症感染症や全身性炎症反応症候群に移行する1）ことから，迅速な診断と治療が重要である．われわれは，発症から24時間以上経過し診断にいたった膿胸を伴う特発性食道破裂に対して，開窓と塩基性線維芽細胞成長因子製剤（以下b-FGF製剤）の胸腔内噴霧により自然閉鎖することができた1例を経験したので報告する．

A 77-year-old man vomited after alcohol drinking and was sent to our hospital by an ambulance due to sustained chest pain. Chest computed tomography （CT） showed pneumothorax and pleural effusion, and thoracic drainage was performed. Since food residue was found from chest drainage and esophagoscopy and esophagography showed injured potion on the left wall of the lower thoracic esophagus perforating to the left thoracic cavity, a spontaneous esophageal rupture was diagnosed. Establishment of fenestration for open drainage and gastrostomy were performed. After 49 days, the fistula was successfully closed by cleaning of the left thoracic cavity, with application of basic fibroblast growth factor and enteral nutrition through gastrostomy. The fenestration was closed after 53 days and the patient was discharged after 78 days.