第10巻 2014年10月　第4号

■臨床医のために

誤嚥性肺炎を認めた逆流性食道炎・食道裂孔ヘルニア患者に対する外科治療；腹腔鏡下逆流防止術の有用性
野村　務¹, 岩切　勝彦², 松谷　毅¹, 萩原　信敏¹, 藤田　逸郎¹, 中村　慶春¹, 金沢　義一¹, 川見　典之², 宮下　正夫³, 内田　英二^1
1日本医科大学消化器外科学
²日本医科大学消化器内科学
³日本医科大学千葉北総病院外科

Surgical Treatment for Patients with Aspiration Pneumonia due to Reflux Esophagitis or Hiatal Hernia: The Usefulness of Laparoscopic Antireflux Surgery
Tsutomu Nomura¹, Katsuhiko Iwakiri², Takeshi Matsutani¹, Nobutoshi Hagiwara¹, Itsuo Fujita¹, Yoshiharu Nakamura¹, Yoshikazu Kanazawa¹, Noriyuki Kawami², Masao Miyashita³ and Eiji Uchida^1
1)Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School
²⁾Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School
³⁾Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital

The incidence of aspiration pneumonia related to gastroesophageal reflux disease in Japan is increasing as the population ages. Such pneumonia tends to recur and to be refractory to conservative treatment because gastroesophageal reflux persists. Laparoscopic surgery provides a reliable treatment for gastroesophageal reflux but is not commonly performed in Japan, especially for patients with poor performance status.
We report our experience treating patients with aspiration pneumonia caused by gastroesophageal reflux. The patients had severe pneumonia that recurred after medical management and resulted in prolonged hospitalization. These patients were referred for surgical treatment and underwent laparoscopic surgery to treat the underlying gastroesophageal reflux. In patients with poor performance status, we also performed laparoscopic gastrostomy for two reasons: 1) to provide a drainage route from the stomach if antireflux effect of surgery was inadequate and 2) to provide a feeding route if performance status did not improve and oral intake was impossible. The outcomes were excellent, the patients were discharged soon after surgery, and aspiration pneumonia has not recurred to date.
In conclusion, laparoscopic antireflux surgery is a useful and promising treatment for patients with recurrent aspiration pneumonia. It may shorten hospital stays and thus reduce medical costs.

日医大医会誌 2014; 10(4), 182-185

Key words
reflux esophagitis, hiatal hernia, aspiration pneumonia, laparoscopic surgery

Correspondence to
Tsutomu Nomura, Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：nomura-t@nms.ac.jp

受付：2014年6月19日　受理：2014年7月14日