咽喉食摘頸部廓清術後に生じたGerstmann症候群の1例

A Case of Gerstmann Syndrome after Total Laryngopharyngectomy and Partial Esophagectomy

I．はじめに

　頭頸部の手術は術野が狭くしかも解剖学的に複雑な構造であるため術後合併症をきたす可能性が高い。　とくに放射線照射後に手術を行う場合，周囲との癒着，壊死，易出血性などにより手術が困難なことがある。

　われわれは喉頭癌で放射線照射後約1年を経過して嚥下困難を生じ，咽頭・喉頭・頸部食道切除術，頸部リンパ節廓清術，頸部食道再建術を施行し，術後に片麻痺とGerstmann症候群をきたした1例を経験したので報告する。

A patient developed necrosis of the larynx and abscess of the neck one year after receiving massive doses of radiation for the treatment of laryngeal cancer. Total laryngopharyngectomy and partial esophagectomy, as well as ligation and resection of the common carotid artery, were performed, but the patient developed Gerstmann syndrome postoperatively. Upon administration of cerebral circulation stimulants and rehabilitation, the symp-toms of Gerstmann syndrome disappeared, but hemiplegia was improved slightly

Because the patients who received massive doses of radiation may have cartilaginous necrosis and damage extending even to the major vessels of the neck, examinations such as the Matas' test, cerebral angiography, and electroencephalography should be performed prior to surgery.