特発性食道破裂に対して腹腔鏡下食道穿孔部修復・縦隔ドレナージ術を施行した1例

Laparoscopic transhiatal repair and transhiatal thoracic drainage for Boerhaave's syndrome : A case report

◆要旨：患者は78歳，女性．関節リウマチにてステロイドと免疫抑制薬で加療中であった．食後の心窩部痛にて救急搬送され，胸腹部造影CT，食道造影から下部食道右側の特発性食道破裂と診断した．胸腔内への穿破を認めなかった．手術は，腹腔鏡下に食道裂孔を開放し，破裂部は2層で縫合閉鎖・修復を行った．汚染は縦隔内に留まっており，胸腔操作は行わなかった．持続洗浄が可能なドレーンを食道腹側・背側に留置した．術後は縫合不全，縦隔炎や膿瘍形成はなく軽快退院した．これまでの食道破裂に対する食道縫合の報告は胸腔内アプローチが多いが，縦隔内に限局する汚染に対しては腹腔鏡を用いて経食道裂孔アプローチで十分治療可能と考えられた．

Spontaneous esophageal rupture, also known as Boerhaave's syndrome（BS）, is an uncommon and potentially lethal pathological condition. We report a case of BS that was successfully treated by primary closure and drainage laparoscopically. A 78-year-old woman was admitted to our hospital with epigastric pain after dinner. A thoracic CT scan revealed mediastinal emphysema. Spontaneous rupture of the esophagus was confirmed on esophagography which demonstrated an evidence of perforation in the right wall of the lower esophagus. We conducted emergent laparoscopic transhiatal approach repair and transhiatal thoracic drainage. The patient was discharged on the 58th post-operative day without a serious postoperative complication. Laparoscopic surgery is effective for spontaneous esophageal rupture with contamination to be confined to the mediastinum.