呼吸障害で発症した乳児咽頭部静脈性血管奇形の1例

Venous malformation of the pharynx presenting with respiratory disturbance in infant：case report

Ⅰ　はじめに

　Venous malformation（VM）は先天性の血管奇形の中で最も頻度が高く，静脈の形成異常によって生じて，体のあらゆる部位に発生し，特に頭頸部領域に多く認められる^{1,2,4～6,8）}。舌，咽頭，気道周囲などに発生したものはmass effectにより気道閉塞を来すことがある^1,4,6,8）。VMの治療には硬化療法，外科的切除，レーザー療法があり，頭頸部領域ではエタノールなどを用いた硬化療法が行われることが多い^1～6,8）。呼吸障害で発症した咽頭部のVMに対して経口的直接穿刺によるエタノール硬化療法を行った乳児例を報告する。

　A one-month old patient developed severe obstructive sleep apnea,and under the diagnosis of infantile hemangioma in the posterior pharynx,he underwent steroid therapy,which resulted in no improvement. Tracheotomy was required at the age of 2 months. Venous malformation was eventually diagnosed at the age of 1 year and 8 months by MR imaging,which also showed a phlebolith in the lesion. To reduce the size of the lesion,ethanol sclerotherapy by transoral puncture was performed at the age of 1 year and 9 months. Subsequently,sclerotherapy was repeated 3 times in the same fashion. Sufficient patency of the nasopharyngeal airway was obtained owing to marked reduction of the lesion size. Tracheotomy was closed 11 months after the first sclerotherapy.

　As conclusion,athough multiple sessions may be necessary,ethanol sclerotherapy by transoral direct puncture is an effective treatment for VM of the pharynx.