内視鏡下レーザーで行った後鼻孔閉鎖症手術の1例

A Case of Unilateral Choanal Atresia Treated by the Laser Endoscopic Surgery

　はじめに

　先天性後鼻孔閉鎖症は比較的まれな疾患である。両側性の場合は生下時より呼吸困難が生じ緊急処置が必要となるが，一側性の場合，症状が現れず，成人まで発見されない例も多い。

　さて後鼻孔閉鎖症の手術は，視野確保，術後再閉鎖など検討すべき問題点を多く含んでいる。われわれは成人で発見された一側性先天性後鼻孔閉鎖症の1例にNd-YAGレーザーを使用した鼻内内視鏡手術を施行した。この経験を報告し，レーザー内視鏡手術に対して考察する。

A 36-year-old man with unilateral choanal atresia was reported. The preoperative diagnosis was made by the radiological and fiberscopic exam-inations. The transnasal endoscopic surgery using YAG laser of contact type was used for correction of the atresia. After vaporizing of mucosa overlying the bony wall, the thick atresia plate was opened, and the opening was enlarged by a rongeur. Further-more, the posterior two-third of the nasal septum was removed for preventing postoperative stenosis. Using the laser and the operative endoscope, effec-tive hemostasis and excellent visualization were obtained during the procedure.