Ichiro Tateya

Angiolytic lasing utilizing the KTP⁄green laser has become a popular means to treat various laryngeal lesions. This laser can photocoagulate vascular lesions with minimal heat damage to surrounding tissues, which is advantageous because it avoids postoperative scar formation on the vocal folds. This laser has proven useful in treating hemangioma, microvascular lesions, hemorrhagic polyp as well as recurrent papillomatosis, dysplasia, and CIS on the vocal folds. Since the laser causes minimal bleeding during the procedure, office based surgery is well indicated. The rationale, set up, and surgical technique are discussed in this manuscript.

53歳女性。患者は嗄声の出現で近医を受診、声門から声門下にかけて広範囲の肉芽が指摘され、その後、呼吸困難となったため、著者らの施設へ紹介となった。受診時、喉頭ファイバースコピーでは両側声門下から前交連にかけて腫瘤がみられ、CTでは気管膜様部に声門下から3cmにわたる内腔に突出する腫瘤、MRIでは同部位にT1・T2強調で低信号を呈する腫瘤が認められた。更に入院後、気道確保で気管切開術が行われ、ファイバースコピーでは声門下に全周性の壁肥厚、膜様部に腫瘤がみられた。一方、穿刺吸引細胞診では確診に至らず、気管喉頭截開術にて声門下腫瘤を切除し、膜様部粘膜を温存して気管部腫瘤の摘出が行われた。その結果、病理診断はアミロイドーシスで、全身検索では他臓器に病変は認められなかったが、術後に腫瘤の再増殖がみられ、再度の喉頭気管截開術で膜様部粘膜の完全切除と輪状軟骨後壁開大術が行われた。目下、術後1年が経過するが、再燃は認められていない。

A flexible tube of 4.9mm in outer diameter and 2.6mm in inner diameter with the tip angle con trollable was newly produced as an instrument for fiberscopic laryngeal surgery. After the bilateral nasal cavities and the pharyngolarynx anesthetized locally, the flexible tube was inserted into the supraglottic space through a nasal cavity under video monitoring with a laryngeal fiberscope inserted through another nasal cavity. A forceps was pushed out from the flexible tube and approximated to a laryngeal lesion with controlling the tip angle and depth of insertion. The lesion was removed care fully with the forceps. Small polyps and epithelial hyperplasias of the vocal folds were easily removed using the tube. The voice was improved after surgery. The flexible tube was useful also in biopsy of the laryngeal tumors.