梨状陥凹拡大を伴う嚥下障害 : 反復性誤嚥性肺炎の1症例 A case report on dysphagia and repeated aspiration pneumonia with expanded piriform sinus

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梨状陥凹拡大を伴う嚥下障害, 反復性誤嚥性肺炎の症例を報告した.症例は88歳女性で, ここ数年嚥下障害に悩まされており, ついには年に2, 3回誤嚥性肺炎を繰り返すようになった.VF検査や造影剤透視検査で右側に比べ左側の梨状陥凹が拡大していることがわかった.また, 気管も造影されていることから誤嚥が生じていると思われた.このような所見から, 手術を施行することとした.余分な梨状陥凹粘膜を切除し, 輪状咽頭筋を切断した.切除部分は肉眼的に正常であったが, 甲状咽頭筋は異常に薄かった.このような手術所見から, 病因は, 何らかの機能的通過障害による慢性的な咽頭内圧上昇と推測した.術後評価として行ったVF検査では, 梨状陥凹は左右対称で, ほぼ正常な嚥下像であった.術後, 嚥下障害は消失し, 現在まで誤嚥性肺炎は認めていない.

We report a case of dysphagia and repeated aspiration pneumonia with expanded piriform sinus. The case is an 88-year-old female, she had suffered from difficulty in swallowing for a several years and finally came to repeat aspiration pneumonia several times a year. In videofluorography and a contrasted study, we observed the left piriform sinus expanded in comparison with the other side. And contrasted trachea suggested that aspiration should exist. Judging from these studies, we decided to perform an operation. We removed the surplus mucous membrane of the piriform sinus and performed cricopharyngeal myotomy. The excision was grossly normal, but thyropharyngeal muscle was abnormally thin. According to these surgical findings, we supposed that etiology was a chronic rise of the pressure in the pharynx because of some functional obstacle in passage. In videofluorography as a postoperative examination, the image of piriform sinuses were symmetrical, and swallowing looked almost normal. After the operation, dysphagia disappeared and aspiration pneumonia has since never been observed.

収録刊行物

  • 口腔・咽頭科 = Stomato-pharyngology

    口腔・咽頭科 = Stomato-pharyngology 13(3), 395-400, 2001-06-01

    日本口腔・咽頭科学会

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