1本の長針で行う経皮的声帯外方移動術

A New Technique of Percutaneous Laterofixation of the Vocal Cord Using a Single Needle

Ⅰ．はじめに

　両側声帯正中固定症に対する声帯外方移動術式の中で，Ejnell法^1）は他の術式と比較して手技が比較的簡便で組織損傷が少なく，術後発声機能も比較的良好であり，1本のナイロン糸で長期間効果が保てることから広く普及している。

　今回われわれは，先端を工夫した1本の長針を用いて1本の2-0ナイロン糸を経皮的に声帯にかけ外方移動させる方法を考案した。特発性両側反回神経麻痺で呼吸状態が悪化した症例に適用して良好な結果を得た。症例を呈示し，手術方法に関して報告する。

A 68-year-old woman who had bilateral vocal cord paralysis was treated by this technique. A utilized needle had a 3mm slit that prepared beforehand at the near end of the needle tip hole so as not to harm but to hold the suture securely in it while the operation procedure. Surgical procedure was as follows；（1）The needle was introduced through the right neck skin and directed through the both thyroid laminae and pierced to the left neck skin. The needle rout was via at the level of both laryngeal ventricles on horizontal plane and at the level of both vocal processes on a coronal plane.（2）A 40cm 2-0 nylon thread was passed through the needle.（3）The needle tip was pulled back to the left vocal cord,and its direction was changed toward just below the left vocal process. The thread was put into the slit and be held on that occasion.（4）The needle pierced again through the left thyroid lamina to the left neck skin.（5）Withdrew the thread from the tip of the needle,and tied firmly and securely by subcutaneous suture technique. Laterofixation of the vocal cord was accompllished in these procedures using a single needle.