Hypopharyngeal web 2症例—その病因に関する考察

HYPOPHARYNGEAL WEBS

　I．緒言

　今回われわれは種々な意味できわめて対照的な2例の下咽頭web症例を経験した。第1例は典型的なPlummer-Vinson症候群であり鉄剤投与が著効を示したが，第2例は大きなweb以外には症状がなく，結局外科的にwebを剔出した。これら2例は臨床所見，経過もまつたく異なつており，Plummer-Vinson症候群の病因を考える上で示唆に富んだ症例であると思われるので，ここにその概要を報告する。合せてPlummer-Vinson症候群およびhypopharyngeal webについての種々の問題点を文献上から取り上げ考察した。ご参考になれば幸甚である。

　Two cases of hypopharyngeal web were reported. Case 1. A woman, aged 48, complained of dysphagia for the period of recent 3 years. Since 3 months ago she began to feel a pain in the back, particularly, when the food was passing through the post-cricoid region. Examination showed the buccal and pharyngeal mucosa to be anemic and the papillae of the tongue were atrophic, but the fingernails failed to show spoon-like effect. The blood examination revealed a normal erythrocyte count but the hemoglobin and serum iron showed a lowered value and the unsaturated iron binding capacity (UIBC) was found to be very high. From these data it was apparent that the patient was suffering from hypochromic and iron defficiency anemia.

　X-ray examination showed a web formationat the post-cricoid region. Esophagoscopy revealed the web to be a scar-formation bulging from the frontal wall of the hypopharynx.

　The patient was treated by means of administering iron therapy, without resorting to any surgical measures, with a complete recovery without recurrence of her former symptoms at present, 3 months after the therapy.

　Case 2. A woman, Aged 72, complained of difficulty in swallowing solid food for the last 30 years. The blood examination showed no anemia or iron defficiency. X-ray examination revealed a wide web formation at the post-cricoid region. Fluoroscopy showed the barium to be detained at the site of the web-formation for a while but at the next moment it was jetted out through a small aperture. Esophagoscopy revealed the lumen of the esohagus to be almost obliterated at the web-formation.

　The patient was operated upon by lateral pharyngotomia, opening the hypopharynx which enabled the removal of the web formation. The wound was closed by end to end suturing of the hypopharyngeal wall. Histologically, the web was found to be composed of fibrous tissues covered with squamous epithelium.