喉頭横隔膜症の治療

TREATMENT OF LARYNGEAL WEB

　I．はじめに

　喉頭横隔膜症は，臨床的に比較的稀な疾患である。本疾患はその成因によつて先天性と後天性にわけられ，後天性のものはさらに炎症性，外傷性および術後性などに分類される。術後性のものは喉頭截開術，気管切開術，パピローマ，声帯結節および声帯ポリープなどの手術後にみられることがある。本症の治療法については喉頭の呼吸，発声両機能の回復を試みた幾多の先人の苦心のあとがうかがわれて興味深い。

　われわれは今回，両側同時に行なつた声帯ポリープ切除後に生じたと思われた喉頭横隔膜症に対して，microlaryngoscopy下に手術を行ない良好な結果を得たので若干の考察を加え報告する。

　A case of postoperative laryngeal web successfully treated under microlaryngoscopic procedure is reported.

　A female teacher, aged 50, developed post-operative laryngeal web following resection of bilateral vocal cord polyp. This web formation resisted conventional surgical treatments such as simple incision or partial resection. The use of silicone plate was then attempted. The silicone plate, half elliptical in shape, 0.8 mm in thickness, was placed between the raw surfaces of the separated web at the anterior commisure under microlaryngoscopy. Twopieces of threads attached to the upper and lower edges of the plate were brought out from the laryngeal cavity through the skin at the suprathyroid notch and at the crycothyroid space, respectively. The threads were ligated. The plate was kept in place for the period of 2 weeks so as to prevent the recurrence of the web formation.

　The voice of the patient showed a considerable improvement following the removal of the plate. The patient returned to her previous job without any clinical signs of recurrence.