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

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. (日本医科大学医学会雑誌 2014; 10: 182―185)