喉摘後に魚骨誤嚥により下咽頭皮膚瘻を形成した症例

Pharyngocutaneous Fistula due to Fish Bone in a Patient with Total Laryngectomy

I．はじめに

　下咽頭皮膚瘻は喉頭あるいは下咽頭悪性腫瘍の術後合併症として頻度の高いものである。その発生に関与する要因として，術前照射・頸部廓清術の同時施行・術前気管切開・ヘモグロビン量の減少・術後感染などが挙げられている^1〜10）。

　われわれは，今回，喉頭全摘後良好な経過を辿っていたが，魚骨誤嚥により瘻孔を形成した珍しい症例を経験したので報告する。

　A pharyngocutaneous fistula due to unnoticed ingestion of a fish bone developed in a patient who received total laryngectomy is reported.

　The patient, 59-year-old male, underwent total laryngectomy for laryngeal cancer, and 11 days after the operation oral feeding was started. The patient developed a fistula in his left lateral neck four days after the initiation of oral feeding, and the next day he noticed another fistula in the right side of the neck.

　Despite of the conservative treatment until 45th postoperative day, the fistulae did not close spontaneously. Therefore, the second operation was performed in order to close the fistulae, and during the operation it was found that there was a fish bone (3.5cm in length) outside the newly formed pharynx beneath the anterior neck skin. A small hole through the pharyngeal mucosa was found at the location where the fish bone was.

　As the patient remained completely painless after ingestion of the fish bone, the fish bone was not detected until the second operation.

　The fistulae were healed after the removal of the fish hone.