腐食性食道炎に対して胸腔鏡下食道全摘術，咽頭・喉頭切除，胃全摘術，胸壁前経路結腸再建を施行した1例

Successful treatment of corrosive esophagitis, pharyngo-laryngitis and gastritis caused by dilute hydrochloric acid : a case report （Video assisted thoracoscopic esophagectomy）

◆要旨：患者は45歳の男性，うつ病による自殺企図にて酸性洗剤を服用し救急搬送された．内視鏡検査で喉頭・下咽頭の浮腫と頸部食道狭窄を認めた．拡張術を施行したが食道穿孔を発症したため，ドレナージを行い，全身状態改善後に，胸腔鏡下に根治術を行った．再建臓器は横行結腸を用いた．術後は順調に経過し経口摂取可能となったが，うつ病の治療と嚥下機能回復訓練に時間を要し，術後109病日に退院した．腐食性食道炎は，炎症の程度によりさまざまな病態を呈すため，各症例に応じた治療法の選択を要する．自験例のように高度な食道狭窄や食道穿孔を伴う場合は手術適応となるが，胸腔鏡下手術は従来の開胸術に比較し，侵襲が少なく有用な術式であると考えられた．

　A 45-year-man attempted suicide by drinking an acid detergent. The patient was taken to a local hospital by ambulance. An endoscopic examination 13 days after admission revealed edema in the hypopharynx and larynx, and stricture in the cervical esophagus. Endoscopic balloon dilation caused esophageal perforation, so he underwent cervical drainage. After his general condition improved, he underwent video-assisted thoracoscopic pharyngo-laryngo-esophagectomy using colon interposition. Finally, he could take solid food, and was discharged on postoperative day 109 after the prolonged treatment of mental disorder. Since the clinical course of corrosive esophagitis is variable, the clinical status of the patient should be considered when determining the optimal course of treatment. Vide-assisted thoracoscopic surgery seems to be an appropriate conservative treatment for the surgical correction of refractory esophageal strictures.