気管支結核および長期気管内挿管後に生じた気管気管支狭窄の1例 Tracheobronchial Stenosis Following Bronchial Tuberculosis and Prolonged Tracheal Intubation

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著者

    • 佐藤 克郎 SATO Katsuro
    • 新潟大学大学院医歯学総合研究科頭頸部外科 Departments of Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 花澤 秀行 HANAZAWA Hideyuki
    • 新潟大学大学院医歯学総合研究科耳鼻咽喉科 Departments of Otolaryngology, Niigata University Graduate School of Medical and Dental Sciences
    • 渡辺 順 WATANABE Jun
    • 新潟大学医学部耳鼻咽喉科 Department of Otolaryngology, Niigata University Faculty of Medicine
    • 高橋 姿 TAKAHASHI Sugata
    • 新潟大学大学院医歯学総合研究科耳鼻咽喉科 Departments of Otolaryngology, Niigata University Graduate School of Medical and Dental Sciences

抄録

再興感染症として注目される結核は肺とともに気管や気管支にも発生し気道狭窄をきたす。今回われわれは,気管支結核の治療に際し長期間気管内挿管をした後に生じた気管気管支狭窄の1例を経験した。症例は33歳女性,20歳時に気管支結核の治療中11カ月間の経鼻気管内挿管が行われ,その後徐々に呼吸困難が進行,気管と右主気管支に高度な狭窄をきたした。初回治療として経皮的心肺補助法を併用し気管切開,KTP-LASERによる狭窄部位の蒸散を行ったが再狭窄を繰り返し,約2年の間にLASERによる再蒸散を2回,Tチューブ留置を2回要した。その後Tチューブは劣化し抜去,気道の観察のため気管切開孔は開存させたままレティナを装用し経過観察中である。本症例の右主気管支病変は当初の気管支結核による影響が,計3回の手術を要した気管狭窄は気管に挿入した装具の刺激の関与が考えられた。本症では気道の形態が1例ごとに異なるため,個々の症例に対する装具の刺激を少なくするきめ細かい治療計画が重要である。また気管切開孔からの長期経過観察は有用であるが,その閉鎖の時期判断が今後の課題と考えられた。

Tuberculosis, recently recognized as a re-emerging infectious disease, sometimes involves the trachea and bronchi and causes subsequent airway stenosis. We herein present a case with tracheobronchial stenosis after prolonged tracheal intubation for the treatment of bronchial tuberculosis. A 33 year-old female, who had been treated and intubated for 11 months with a diagnosis of bronchial tuberculosis, developed a slowly progressive dyspnea, and a severe tracheobronchial stenosis was observed. As an initial treatment, tracheostomy and vaporization of the stenosis using KTP-LASER under percutaneous cardiopulmonary support was performed, but further surgery using LASER and T-tube placement was required due to the reappearance of the stenosis. One year after the removal of the T-tube (six months after the second surgery), T-tube replacement, combined with LASER surgery was needed because of repeated stenosis. Finally, 1 year after the third surgery, the T-tube was removed due to a deterioration in the tube, and the patient has been followedup with a patent tracheostoma, which has been used for direct observation of her airway, while wearing a Retainer. The bronchial lesion in this case was was probably due to direct involvement of bronchial tuberculosis, but the repeated tracheal stenosis, which required several surgeries, might have affected the stenting instruments inserted into the airway. Because the morphology of the air way in cases with this disease differ, careful treatment strategies are required in order to reduce the irritation caused by instruments to the airway. Although direct observation of airway through a patent tracheostoma is useful, the timing of the closure of the tracheostoma also needs careful planning.

収録刊行物

  • 日本気管食道科学会会報

    日本気管食道科学会会報 55(3), 270-275, 2004-06-10

    特定非営利活動法人 日本気管食道科学会

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各種コード

  • NII論文ID(NAID)
    10013294187
  • NII書誌ID(NCID)
    AN00187474
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00290645
  • データ提供元
    CJP書誌  J-STAGE 
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