喉頭癌に対するCricohyoidoepiglottopexy後の嚥下機能の検討  [in Japanese] Swallowing Function after Near-Total Laryngectomy ,Cricohyoidoepiglottopexy (CHEP), and Cricohyoidopexy (CHP)  [in Japanese]

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Author(s)

    • 八尾 和雄 YAO Kazuo
    • 北里大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
    • 永井 浩巳 NAGAI Hiromi
    • 北里大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
    • 伊藤 昭彦 ITO Akihiko
    • 北里大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
    • 横堀 学 YOKOHORI Satoru
    • 北里大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
    • 岡本 牧人 OKAMOTO Makito
    • 北里大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara

Abstract

喉頭亜全摘Cricohyoidoepiglottopexy (CHEP: 4例) およびCricohyoidopexy (CHP: 1例) 術後の嚥下訓練と嚥下機能の獲得過程について検討した.<BR>嚥下訓練の実際と下咽頭食道透視検査を解析した結果, 嚥下機能獲得の過程は次の3つの時期に分けることができた. I-初期: 食塊は気管に直接侵入する. II-中期: 食塊は喉頭入口部と気管切開孔の間の上部気道で停滞する. III-後期: 食塊は食道に直接入る. 嚥下機能の獲得が完了に近い状態である. 初期は2-14日と最も短く, 中期が7-80日と最も時間を要した. 後期は7-15日であった.<BR>術後嚥下機能の客観的評価にMTF (Method, Time, Food) スコアを用いた. CHEPの3症例は訓練開始直後から比較的高得点を示し, それぞれ1ヵ月以内の訓練期間で15点満点の機能を獲得した. 他の2症例は異なった理由で声門の閉鎖が十分ではなく, 嚥下の獲得が困難であった. この傾向はMTFスコア (10-11点) にも反映されていた.<BR>CHEPおよびCHPの嚥下練習に際しては個々の症例に合わせたきめこまやかな配慮が大切である. 訓練には医師のみでなく, 看護婦, 言語聴覚士, 理学療法士, 栄養士の各職種が連携を取りチーム医療で臨むことが理想であり, 今後このような系統的訓練のマニュアル作りが必要であると思われた.

We studied postoperative swallowing in 4 patients undergoing CHEP and 1 undergoing CHP. Swallowing was obtained by intense swallowing rehabilitation since only 1/4 of the larynx remained after near-total laryngectomy. Our swallowing rehabilitation program is detailed in this paper.<BR>The improvement of swallowing is classified into 3 stages. In stage I, volus directly intrudes into the trachea. In stage II, volus stagnates between laryngeal inlet and tracheal stoma. In stage III, volus directly flows through the esophageal inlet. Stage III indicates that rehabilitation is almost completed. Stage I is shortest at 2 to 14 days and Stage II longest at 7 to 80 days.<BR>The MTF (Method, Time, Food) score described by Fujimoto et al was used to analyze swallowing. Three cases following CHEP showed high scores shortly after the introduction of rehabilitation and reached the maximum score at discharge (15 points=normal swallowing). At present, these 3 patients are satisfied with swallowing and enjoy a good quality of life. In 2 other cases (1 CHEP and 1 CHP), both had a wide laryngeal inlet and still have some difficulty with liquids. Further modification of the surgical technique is needed especially for CHP.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 105(1), 8-13, 2002-01-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  12

Cited by:  4

Codes

  • NII Article ID (NAID)
    10008095335
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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