喉頭癌に対する放射線治療後に下咽頭壊死および降下性壊死性縦隔炎を生じた1例

Radionecrosis of the Hypopharynx and Subsequent Descending Necrotizing Mediastinitis after Radiotherapy for Laryngeal Carcinoma

I．はじめに

　早期喉頭癌の放射線治療は，喉頭温存目的の第一選択とされる治療方法である。今回われわれは，喉頭癌に対して行った放射線治療後に，下咽頭壊死および降下性壊死性縦隔炎を生じた症例を経験した。降下性壊死性縦隔炎は，早期に適切な治療が施されないと致命的となる疾患である^1）。外科的治療により救命し，その後，下咽頭の再建を要した症例の治療経験を報告する。

We present a rare case of radionecrosis of the hypopharynx and subsequent descending necrotizing mediastinitis after radiotherapy for T2 laryngeal carcinoma. A fiberoptic examination revealed massive necrosis in the hypopharynx without intralaryngeal abnormalities. In spite of the medical treatment,his conditions were deteriorated. A computed tomography showed extensive air density areas from the retropharynx to the mediastinum. Transcervical and subxiphoid drainage surgery led to success in controlling the infection. However,total pharyngolaryngectomy and reconstruction with free jejunal transfer were necessitated to resume the oral intake because the necrotizing infection resulted in irreversible total mucosal defects of the hypopharyngeal wall.