Noriaki Maekawa

A Case of Epiphrenic Esophageal Diverticulum Associated with Esophageal Dysmotility.

食道運動異常と胃食道逆流を伴う横隔膜上食道憩室に外科的な処置を加え良好な結果を得たので報告する.患者は71歳の女性で, 嚥下困難を主訴として来院.上部消化管造影で下部食道に憩室を認め, 内視鏡で憩室炎を認めた.食道内圧測定では憩室より上部の食道に嚥下に伴う正常な蠕動波が認められず, 24時間食道内pH測定では明らかな酸逆流を認めた.手術としては経胸的憩室切除術にBelseyの噴門形成術を付加した.切除標本は組織学的には炎症所見のみで悪性所見はなかった.われわれは食道憩室では食道内圧測定や24時間食道内pH測定検査を行い, 憩室切除術のみではなく病態に応じた付加治療を考慮すべきであると考える.

Experimental Study on Function of the Upper Esophageal Sphincter After Radical Operation for Esophageal Cancer

The upper esophageal sphincter (UES), located between the esophagus and the pharynx, provides a barrier against esophagopharyngeal reflux and subsequent aspiration of intraesophageal contents such as food or digestive juices. This consists of the cricopharyngeus muscle and the upper part of esophageal circular muscle. The UES is presented as a high pressure zone manometrically, with the pressure (UESP) higher than pharyngeal or esophageal pressure, i.e., around 39mmHg as reported by Tokuhara et al. [1], and the length of this high pressure zone is about 2–4 cm.

Bypass Operation with Pedicled Jejunum for Unresectable Intrathoracic Esophageal Cancer

The number of cases of intrathoracic esophageal cancer detected early has been increasing in Japan, but most cases are still advanced when detected. Such cancer readily infiltrates the aorta, trachea, and lungs due to their anatomical proximity, and combined resection can be difficult, often preventing curative excision. The bypass operation performed for such patients is only palliative therapy, but it can make discharge from hospital possible if the patient can eat.

Usefulness of Posterior Mediastinal Reconstruction After Esophagectomy in Case of Esophageal Cancer with Palsy of Recurrent Laryngeal Nerve

In cases of esophageal cancer, metastasis to the lymph nodes alongside the recurrent laryngeal nerve (RLN) is found in high incidence, namely 25%. Palsy of the RLN may develop after the dissection of these nodes, even if the nerves were preserved surgically. In patients with metastasis to these nodes, the palsy of the RLN is observed before operation. Functional changes in the pharynx and cervical esophagus after the reconstruction of the intrathoracic esophagus have not yet been reported. To find an appropriate reconstructive procedure in the cases of esophageal cancer with palsy of the RLN, postoperative swallowing function was examined quantitatively by scintigraphy in the patients who had undergone a reconstruction via various routes.

Report of a case undergone successful gastrectomy for gastric cancer in the fornix with esophageal mycosis.

76歳男性, 約10年前より糖尿病のため経口血糖降下剤を服用.72歳時に軽度の嚥下困難に対して精査を行い, 頸部食道から噴門部直上におよぶ食道真菌症と診断し, 抗真菌薬の投与にて経過観察中であった.3年後の上部消化管造影で, 胃穹窪部の隆起性病変を発見し, 生検で腺癌の診断を得た.開腹所見では腫瘍は噴門部大弯側前壁にあり, 食道胃接合部との間に約3cmの正常粘膜を有していた.そこで腫瘍の口側距離 (OW) を2cmとり, しかも食道胃接合部より1cm遠位側の胃粘膜と小腸とを吻合する胃全摘術を施行した.術後体表に創感染を認めた以外良好に経過した.食道真菌症に胃癌を合併した例 (以下本症) の報告は検索範囲ではなく, 本症に対して胃全摘術後, 真菌症罹患食道との再建術では縫合不全が危惧される.今回は幸運にも罹患食道との吻合を行わずに治癒切除しえたが, 場合により危険度の高い吻合もありえたため本症に対する再建術の2, 3の工夫を考察した.

Reconstructive Procedures for Total or Proximal Gastrectomy and Postoperative Reflux

A total of 325 patients with gastric cancer were subjected to total gastrectomy and proximal gastrectomy at our clinic during the 20-years period from 1965 to 1984. The incidence of postoperative esophagitis was as high as 24% in the 106 cases treated during the first 9 years. In 1974, therefore, we started to employ the following reconstructive procedures for the prevention of this complication: (1) procedures following total gastrectomy: (a) Roux-en Y, in which a distance of 40 cm was taken between anastomoses (esophagus-jejunojejunostomy) and (b) jejunal interposition between the esophagus and duodenum, in which a jejunal segment 40 cm long was used; and (2) procedure following proximal gastrectomy: jejunal interposition between the esophagus and stomach, in which a jejunal segment of appropriate length was used so that the distance between anastomoses came to 40 cm. As a consequence, the incidence of postoperative endoscopic esophagitis was reduced to 3.7%. However, 13% of the patients who received total gastrectomy and 18% of those who received proximal gastrectomy still complained of reflux symptoms. These incidences were higher than that determined after subtotal gastrectomy.