喉頭横隔膜症に対する手術の工夫

SOME IMPROVEMENTS IN SURGICAL PROCEDURES FOR LARYNGEAL WEB

　I．はじめに

　喉頭横隔膜症の手術法は，大別すると甲状軟骨截開下に行なう方法^{4）6）7）8）10）}，直達鏡下に行なう方法^{1）3）4）11）}，seton串（カン）線を利用する方法^14）の3種類がある。単なる切離または切除だけでは，ほとんど常に再癒着を生ずる。われわれは最近，甲状軟骨截開下に行なう方法と直達鏡下に行なう方法について，従来の方法に若干工夫を加えて好結果を得たので報告する。

　なお"横隔膜"という語は，web（英），Segel（独）の意味を表わすには適当ではないが，慣用されているので，一応そのまま用いることにする。

　This paper describes two improved surgicalprocedures for laryngeal web. In one procedure, web is sectioned or removed under thyrotomy. The wound on the vocal folds is primarily closed with sutures. The anterior cut-end of the mucosa is sutured to the sternohyoid fascia to prevent web formation. No keel is demanded. This procedure eliminates secondary surgery to remove the keel. In the other technique, web is sectioned or removed under a direct laryngoscope. A silicon plate is inserted in the same way as Frazer's or Nessel's technique except that the threads are tied in front of the thyroid cartilage. A small skin incision is necessary for this purpose. This technique assures better fixation of the plate as compared to the techniques in which the threads are tied in front of the cervical skin. Seven cases treated with either one of these techniques are presented.