横隔膜上食道憩室に対して胸腔鏡下憩室切除術を施行した1例

Thoracoscopic diverticulectomy for epiphrenic diverticulum

◆要旨：患者は67歳，女性．逆流性食道炎の診断で加療中に，症状の増悪を認め紹介となった．上部消化管内視鏡検査で横隔膜上食道憩室と軽度の食道裂孔ヘルニアを認めたが逆流性食道炎は認めず，上部消化管造影検査で5cm大の食道憩室と側臥位で造影剤が食道内に逆流する所見を認めた．以上より自覚症状の原因は憩室内容の逆流と考え，胸腔鏡下憩室切除術を施行した．病理結果は真性憩室であった．本症例では憩室の位置と腹腔鏡操作による食道裂孔ヘルニアの悪化を考慮して，胸腔鏡下での憩室切除を選択し，術後主訴の著明な改善を認めた．今回筆者らは横隔膜上食道憩室に対して胸腔鏡下憩室切除術を施行した1例を経験したため文献的考察を加え報告する．

A 67-year-old woman presented with regurgitation. Endoscopic examination disclosed a large epiphrenic diverticulum and esophageal hiatal hernia but no reflux esophagitis. A barium swallow showed pooling of barium in the diverticulum measuring 5 cm in length and barium reflex into the esophagus in the lateral decubitus position. Chest computed tomography showed an esophageal diverticulum with fluid collection near the left diaphragm. Therefore, we considered that the epiphrenic diverticulum had caused the regurgitation, and thoracoscopic diverticulectomy was performed. Postoperative course was uneventful. Histopathological finding showed a true diverticulum with preserved musculare layer. Epiphrenic diverticula are uncommon, and recently, minimally invasive thoracoscopic and laparoscopic approaches for treatment have been reported in a few series. However, the best surgical approach remains uncertain. We proposed that thoracoscopic surgery could be a possible standard operative approach for a large epiphrenic diverticulum.