慢性严重误吸的手术治疗

Surgical treatment for the chronic severe aspiration

目的 :探讨不同病因所致慢性严重误吸患者的最佳手术治疗方式。方法 :对 8例慢性严重误吸患者分别采用 3种手术方式治疗 :①气管切开术 (5例 )、颈气管永久性造瘘术 (1例 ) ,气管套管佩带气囊 ,进食时气囊充气以阻止误吸 ;②会厌瓣缝合术 (即喉口闭锁术 ,1例 ) ;③胃永久性造瘘术 (1例 )。结果 :8例患者均能经口进食 ,食物的性状种类不受限制 ,且未发现吸入性肺炎。其中 5例带气囊者仅在进食后放气时 ,略有轻微刺激性咳嗽 ,1例喉癌行Arslan术式者 ,仍有较轻误吸现象 ,以上 6例患者堵管时均能发声 ,可日常交谈 ;1例采用会厌瓣缝合术患者 ,术后经口进食已完全杜绝误吸现象 ;1例行胃永久性造瘘术者 ,能较好解决进食误吸 ,无胃反流现象。结论 :会厌瓣缝合术 (喉口闭锁术 )、气管切开术 (或颈气管永久性造瘘术 )和胃永久性造瘘术 3种术式 ,均是解决慢性误吸的外科治疗方法 ,可依不同的病因及患者的具体情况选择最佳术式。

Objective:To find out the best surgical treatment for chronic severe aspiration with different pathogenesis.Method:Eight patients with severe aspiration were treated by 3 surgical methods.Six of 8 cases were perfomed tracheotomy.The cannula had a gasbag and the gasbag was inflated before eating food every time.Epiglottic flap closure for one patient with intractable aspiration.Stomach stomy for the case with tracheoasophageal fistula.Result:There did not found aspiratory pneumonia in all cases after following up for 9 months to 4.5 years. The six cases with tracheotomy could eating normally and their phonation were reserved.Only one case has a slight aspiration. The patient with epiglottic flap closure hadn't aspirated when eating. The stomach stomy could prevent the aspiration in having meal.Conclusion:Tracheotomy, epiglottic flap closure and stomach stomy are all the effective surgical treatment for chronic severe aspiration.Any of 3 surgical methods should be selected according to the etiology, the degree of aspiration and the patient's condition,so as to improve the quality of the patient's life.