Sacculotomyと側頭骨病理

SACCULOTOMY. CLINICOPATHOLOGICAL OBSERVATIONS

　I．はじめに

　1964年にIzak Fickによつてはじめてsaccu-lotomyがメニエール病に対する内リンパ水腫除去手段として，発表されて以来^1）2）Arslan^3），Proud^4），Smyth^5），Antoli-Candela^6）らにより追試され，またsacculotomyの欠点を補うものとしてCody^7）8）のtack operationも発表されているが，いずれの場合も眩暈に関しては良好な治癒成績を高率にあげているが，聴力に関しては成績が甘ばしくないと発表されている。

　われわれは典型的なメニエール病に対して各種の内リンパ減荷手術を試みているが，うち10例に対してsacculotomyを行なつたので，その手術成績を検討すると共に，著者の1人がPensacolaの航空宇宙医学研究所滞在中に行なつたリス猿の実験的内耳手術後の側頭骨病理標本と対比することによつて，メニエール病に対するsacculotomyの内耳病理に及ぼす影響について考察を加えたので諸賢のご批判を得たいと思う。

　The results of 10 cases of Ménière's disease in whom sacculotomy was performed for relief of symptoms are reported. For an experimental study, the saccular membrane of the normal squirrel monkeys is ruptured and the results are observed.

　Clinically, when sacculotomy is performed the symptoms such as vertigo and the sensation of fulness of the ear are abated but it failed to manifest improvement of hearing. Eight out of 10 cases of sacculotomized patients reported re-lief of vertigo and the sensation of the fulness of the ear. But, 5 out of the 10 of these patients complained of hearing detriorations.

　The pathological findings of sacculotomy in the experimental animals were as follows:

　1) No obvious pathological lesion is found in the sensory epithelium of the inner ear,

　2) An early healing of the rupture in the saccular membrane is evident,

　3) A pinkish clored precipitate is seen the endolymphatic sac,

　4) Perilymphatitis is evidenced in the scala vestibuli, and,

　5) Changes are seen in the tension of the Reissner's membrane.

　These otopathological findings in the experimental sacculotomy which apparently involve various parts of the cochlea seem to be one of the reason for occurrence of hearing deterioration in the human ear when sacculotomy is performed for the treatment of Meniere's disease.