食道切除既往歴のある患者に対し、正中胸骨切開術を介したオフポンプ冠動脈バイパスグラフト術を施行した症例の報告

Off-pump coronary artery bypass grafting via median sternotomy in a patient with a history of esophagectomy with substernal gastric tube reconstruction: report of a case.

• Noriyuki Kashiyama
• Koichi Toda
• Shigeru Miyagawa
• Hiroyuki Nishi
• Yasushi Yoshikawa
• Satsuki Fukushima
• Daisuke Yoshioka
• Kawamura Masashi
• Tetsuya Saito
• Yoshiki Sawa

抄録

40年前に食道癌のために食道切除術と胃管再建術を行った三枝病による不安定狭心症患者に対し、OPCAB（off-pump coronary artery bypass grafting）を成功させた。術前に多検出器列コンピュータ断層撮影を行い，胃管の経過と胃管に栄養を供給している胃尖動脈の経過を評価した．慎重に胸部再挿入を行い、適切な剥離を行った後、胃管を傷つけたり、血行動態を不安定にしたりすることなく、OPCABは正中胸骨切開術で安全に行われた。術後初期の経過は問題なかった。

We performed successful off-pump coronary artery bypass grafting (OPCAB) in a patient with unstable angina caused by triple-vessel disease, who had undergone esophagectomy with substernal gastric tube reconstruction for esophageal cancer 40 years earlier. Preoperative multidetector-row computed tomography was done to evaluate the course of the gastric tube and also that of the gastroepiploic artery, which feeds the gastric tube. Following careful sternal re-entry and adequate dissection, OPCAB was performed safely via a median sternotomy without injuring the gastric tube or causing hemodynamic instability. The patient had an uneventful early postoperative course.