食道癌術後，挙上胃管にESD後の遅発性穿孔をきたした1例

A case of delayed perforation of the gastric tube due to ESD in a post-operative esophageal cancer patient

◆要旨：患者は61歳，男性．健診で異常を指摘され当院を受診し，食道癌，胃癌と診断された．食道切除術の7日前に，胃癌に対し内視鏡的粘膜下層剝離術（ESD）を施行した．食道癌は胸腔鏡腹腔鏡下食道亜全摘術を施行し，後縦隔経路で細径胃管再建とした．術後6日目に胸腔ドレーン排液が増加し，呼吸状態が悪化し再手術を行った．胸腔鏡下に観察すると胃管のESD部に1cm大の穿孔を認めた．胸腔鏡下に穿孔部を閉鎖し，胸腔ドレーンを挿入して手術を終了した．術後は呼吸不全，膿胸が遷延したが術後第42日目に退院となった．食道癌術後の膿胸は重篤な合併症であるが，今回その原因が細径胃管のESD後の遅発性穿孔であった稀な症例を経験した．

　A 61-year-old man was admitted to our hospital because of an abnormality in medical examination and was diagnosed as esophageal cancer and gastric cancer. Endoscopic submucosal dissection （ESD） was performed for gastric cancer, seven days before esophagectomy. Thoracoscopic laparoscopic esophagectomy and reconstruction of small-diameter gastric tube in the posterior mediastinal canal was performed for the esophageal cancer. On the 6th postoperative day, chest cavity efflux increased, respiratory condition worsened and re-operation was performed. Observation under thoracoscopy revealed a perforation of 1 cm in the post-ESD part of the gastric tube. The perforation was closed under thoracoscope, a thoracic drain was inserted and the operation was completed. After the operation, respiratory failure and empyema were prolonged but the patient was discharged on the 42nd postoperative day. We experienced a rare case of delayed perforation after ESD in the gastric tube.