治療に難渋した術後性下咽頭狭窄の1例

A Case of Postoperative Hypopharyngeal Stenosis with Difficult Reconstruction

　はじめに

　下咽頭や頸部食道の悪性腫瘍手術では，腫瘍も含めた広範な切除および一期的再建は日常的に行われており，良好な予後を得ている。しかし，術後かなりの年月を経た後，新たに下咽頭や頸部食道の瘢痕性狭窄をきたすことも稀ではない。その場合，たいていは保存的治療が効を奏すことが多いが，根治には至らないこともある。

　今回われわれは，術後11年目に大胸筋皮弁を用いて瘢痕性下咽頭狭窄部を再建し，良好な結果を得た1例を経験したので，症例の詳細な経過とともに文献的考察を加えて報告する。

A 70-year-old male received radiation with 60 Gy, delivered Cobalt 60 unit for hypopharyngeal area after operation of hypopharyngeal carcinoma in 1985.

Six years later, he complained of dysphagia. Exa-minations showed that the hypopharynx was extremely narrowed but no malignancy was found in the pharynx.

It was suspected that the hypopharyngeal stenosis was caused by postradiation fibrosis. The conserva-tive procedures with Celestin dilator and esophageal balloon catheter were performed several times from 1991 to 1996, but it was not effective. The radical procedures with reconstruction by PMMC-flap were performed in 1996. This method was effective.