気管狭窄解除後マイトマイシンC局所塗布を併用し,再狭窄を回避しえた1症例 [in Japanese] Tracheal Scar Stenosis Treated with Mitomycin-C Topical Application During Tracheo-bronchial Intervention [in Japanese]
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背景.マイトマイシンC(MMC)は肉芽増生抑制の効果が報告されており,世界では良性疾患による気道狭窄症例に対してMMC局所塗布併用治療が多数行われている.日本ではこの治療法の報告は稀である.症例. 31歳の男性. 18歳の時に全身麻酔下で左大腿骨骨折の治療を受けた.1年前より咽頭部の違和感を自覚し, 8か月前から吸気時の喘鳴を周囲から指摘されていた.近医を受診し内服処方を受けたが改善せず,当院呼吸器内科に紹介された.気管支鏡検査で声帯より約3cm末梢側に全周性の瘢痕性狭窄を認めた.気管インターベンションの適応と判断され当科紹介となった.当科にて硬性鏡下手術を行い,瘢痕部位を切除し,切除部位にはMMCを局所塗布した.結果.術後の経過は特に問題なく1週間で退院することができた.術後3か月の気管支鏡検査では肉芽増生や瘢痕組織による再狭窄を認めなかった.現在術後3年経過し,再発なく経過している.結論.さらに長期の経過観察が必要ではあるが, MMCの肉芽増生抑制効果が気道狭窄の再発予防に有用である可能性が考えられた.
Background. Mitomycin-C (MMC) reportedly has an effect on granulation suppression, and many cases of tracheal stenosis caused by benign disease have received topical MMC treatment worldwide. However, in Japan, this treatment modality is still rarely used. Case Report. A 31-year-old man received treatment for a fracture of his left femur under general anesthesia when he was 18 years old. He became aware of discomfort in his pharyngeal portion one year previously, and he had wheezing 8 months ago. He went to hospital and was prescribed medicine. However, as no improvement was made, he was finally referred to our Respiratory Medicine department. Bronchoscopy showed scarring stenosis of the entire tracheal circumference approximately 3 cm away from the vocal cord to the peripheral side, so he was referred to us for bronchial intervention. In the operation, we resected scar tissue, and applied MMC to the resected area. Result. The postoperative course was non-eventful and the patient was discharged from hospital one week later. At bronchoscopic examination 3 months after surgery, there was no restenosis by granulation and/or scar tissue hyperplasia. There has been no recurrence 3 years after surgery. Conclusion. Although long-term follow-up is necessary to confirm these results, we believe that the suppressive effect of MMC on granulation hyperplasia could be effective in preventing relapse of tracheal stenosis.
- The Journal of the Japan Society for Respiratory Endoscopy
The Journal of the Japan Society for Respiratory Endoscopy 37(1), 39-43, 2015
The Japan Society for Respiratory Endoscopy