5．頸部気管形成

Laryngotracheal Resection and Reconstruction

頸部気管形成には，気管だけでなく喉頭についての知識・手技が必要となる．術前に頸部気管のみに限局している病変と思われても，術中に喉頭部の操作が必要となる症例は少なくない．この喉頭・気管にまたがる領域は耳鼻咽喉科と呼吸器外科の境界領域であり，本邦では双方に精通した医師はきわめて少ない現実がある．筆者は，肺移植臨床のためVienna医科大学胸部外科に留学していたが，幸運にも本領域の手術についても専門的かつ系統的なトレーニングを受ける機会を得た．

Cervical tracheoplasty requires knowledge and skills not only of the trachea but also of the larynx. Even if the lesion is thought preoperatively to be confined to the cervical trachea, intraoperative manipulation of the larynx is often necessary. This area that involves the larynx and trachea is a borderline between otorhinolaryngology and thoracic surgery, and there are very few surgeons in Japan who are well trained in both areas. The author studied at the Department of Thoracic Surgery at the Medical University of Vienna for clinical lung transplantation and was fortunate to have the opportunity to receive specialized and systematic training in this laryngotracheal surgery as well. This article describes the techniques and tips for “laryngotracheal surgery” focusing on “tracheal resection and reconstruction” and “cricotracheal resection and reconstruction” for benign airway stenosis, which I learned in Vienna and am now practicing at Fukuoka University. In addition, it also discusses the basic concepts for malignant diseases of the area.