Kawasaki Naruo, Suzuki Yutaka, Omura Nobuo, Tsuboi Kazuto, Matsumoto Akira, Kashiwagi Hideyuki, Yanaga Katsuhiko
Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Surg Today. 2007;37(10):897-900. doi: 10.1007/s00595-007-3505-9. Epub 2007 Sep 26.
A 56-year-old woman underwent a laparoscopic Heller-Dor operation for esophageal achalasia in June 2002. As dysphagia became exacerbated and the oral intake became extremely poor, an esophagectomy was thus considered to be indicated. In September 2005, a transhiatal esophagectomy was performed, and the esophagus was reconstructed using a gastric tube through the posterior mediastinum. The patient developed pneumonia postoperatively, but responded to conservative therapy and was discharged in good health 30 days after surgery. A histopathological analysis demonstrated degeneration and a loss of gangliocytes throughout the esophagus as well as the presence of seven intramucosal cancers. The main cause of dysphagia was due to a marked flexion of the upper esophagus. Even though we identified a precancerous state, we believe that surgery was an appropriate option in this case.
一名56岁女性于2002年6月接受了腹腔镜下Heller-Dor手术治疗食管贲门失弛缓症。由于吞咽困难加重且经口摄入量极差，因此考虑行食管切除术。2005年9月，进行了经胸食管切除术，并通过后纵隔使用胃管重建食管。患者术后发生肺炎，但经保守治疗后好转，术后30天健康出院。组织病理学分析显示整个食管神经节细胞变性和缺失，以及存在7处黏膜内癌。吞咽困难的主要原因是食管上段明显弯曲。尽管我们发现了癌前状态，但我们认为在这种情况下手术是合适的选择。
