特発性食道破裂の4例  [in Japanese] FOUR CASES OF SPONTANEOUS ESOPHAGEAL RUPTURE  [in Japanese]

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Abstract

当院で経験した4例の特発性食道破裂について検討した.年齢は35~72歳,いずれも男性.全例飲酒を契機とした嘔吐により発症し,胸部下部食道左壁の破裂を認めた.破裂長径は1.5~5.0cm (中央値3.7cm)で,全例前医にて診断を得て紹介され,入院同日に手術を行った.発症から手術開始までに要した経過時間は,順に17, 12, 48, 19時間であった.全例一期的縫合閉鎖を施行,それに加え横隔膜被覆を行ったものが1例, pericardial fat padを被覆したものが1例, fundic patch & fundoplicationを行ったものが1例であった.全例救命しえたが,術後2例に胃食道逆流症状を認めた. fundic patch & fundoplicationを行った症例は,最も経過良好であった.本疾患は,術後晩期合併症である胃食道逆流症状(gastro-esophageal reflex disease:以下GERDと略記)を訴える症例が少なからずみうけられる.このため救命はもちろん, QOLを考慮した治療法を選択しなければならない.食道裂孔付近の破裂で長径5 cm以上もしくは発症後12時間以上経過した症例などでは,縫合不全およびGERD予防の点からもfundic patchおよびfundoplicationを行うことが有効と考える.

We report 4 cases of spontaneous esophageal rupture. All were man 35-72 years old, and admitted for sudden severe chest pain after drinking and vomiting. All had ruptures in the left wall of the esophagus (Lt) from 1.5 cm to 5.0 cm long. Surgery started 17, 12, 48, and 19 hours from onset. All underwent primary suturing, among whom three were added a diaphragm patch, a pericardial fat patch, or a fundic patch with fundoplication. Postoperative courses were uneventful and all survived.<br>The case with fundic patch and fundoplication had the best postoperative course.<br>Spontaneous esophageal rupture sometimes is complicated by gastroesophageal reflex disease (GERD) after surgery and we recommend fundic patch and fundoplication to prevent this.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 65(6), 1524-1528, 2004-06-25

    Japan Surgical Association

References:  10

Cited by:  4

Codes

  • NII Article ID (NAID)
    10013301913
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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