Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan.
Dig Endosc. 2017 Nov;29(7):806-810. doi: 10.1111/den.12927. Epub 2017 Sep 7.
A 43-year-old man with complaints of increased difficulty swallowing and weight loss underwent videofluorographic examination of swallowing, which revealed severely reduced cricopharyngeal opening. Endoscopic cricopharyngeal myotomy was carried out using a modified technique (mECPM). A benign fibrotic stricture of the upper esophageal sphincter (UES) was identified under visualization of a distending operating laryngoscope. A vertical midline incision in the strictured mucosa and submucosal resection of the cricopharyngeal muscle were done using a CO laser. The initial vertical mucosal incision was tightly sutured in the horizontal direction with absorbable surgical sutures. Histopathological examination of the cricopharyngeal muscle revealed infiltration of inflammatory cells. The patient started oral intake on postoperative day 7. He has been symptom free for 2 years with an improved body mass index, and postoperative laryngoscopy revealed no salivary retention in the piriform sinuses. The technique presented here provides sufficient opening of the UES by eliminating the problem of restenosis. mECPM will be useful for treating benign fibrotic strictures of the UES.
一位 43 岁男性因吞咽困难和体重减轻就诊，行吞咽功能视频造影检查，显示环咽肌开口严重缩小。采用改良技术（mECPM）行内镜下环咽肌切开术。在可视性扩张式操作喉镜下，发现上食管括约肌（UES）良性纤维性狭窄。在狭窄的黏膜正中做一垂直切口，并用 CO 激光切除环咽肌。先用可吸收外科缝线在水平方向上紧密缝合最初的垂直黏膜切口。环咽肌的组织病理学检查显示炎症细胞浸润。术后第 7 天患者开始经口进食。他已无症状 2 年，体重指数改善，术后喉镜检查显示梨状窦无唾液潴留。本文介绍的技术通过消除再狭窄问题提供了 UES 的充分开放。mECPM 将有助于治疗 UES 的良性纤维性狭窄。
