嚥下機能改善手術症例の臨床的検討  [in Japanese] Evaluation of Surgical Intervention to Improve Swallowing Function  [in Japanese]

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Abstract

<p>高度の嚥下障害に対して,経口摂取の回復を目的とした外科的治療は有効な治療手段である。今回,われわれは2008年~2014年の間に嚥下機能改善手術を行った15例の術後経過を後方視的に検討し,手術適応と限界について考察を加えた。症例の年齢は43~87歳,男女比は12 : 3であった。嚥下障害の原因は脳血管障害が10例,加齢が3例,その他2例であった。嚥下機能は藤島らの摂食状況レベル評価法と兵頭らの嚥下内視鏡検査スコア評価法により評価した。摂食状況レベルは術後 (退院時,最良時,最終受診時) に有意に改善したが,高齢者では経過中に悪化がみられた。嚥下内視鏡検査スコアも術後 (退院時,最良時) には有意に改善がみられた。7例では経過中に嚥下内視鏡検査スコアが悪化したが,そのうちの6例では経口摂取は継続できていた。70歳代後半以降の高齢者では,ALDや認知機能の低下により手術効果が満足すべきものではなかった。手術後のリハビリテーションや療養支援プランは予め検討しておくべきと考える。</p>

<p>Surgical intervention aiming to restore oral feeding is an effective treatment option for patients with severe swallowing disorder. In this article, we retrospectively analyzed the postoperative courses of 15 patients who underwent surgical interventions to improve swallowing function between 2008 and 2014, and discussed their indications and limitations. The patients ranged in age from 43 to 87 years, and they consisted of 12 males and 3 females. The causes of swallowing disorder were cerebrovascular disorder in 10 patients, increasing age in 3, and other causes in 2. Swallowing function was evaluated by the Food Intake Level Scale (FILS) devised by Fujishima et al. and the flexible endoscopic evaluation score of swallowing (FEESS) devised by Hyodo et al. The evaluation data was collected from pre- and postoperative examinations. FILS scores improved significantly after the operations (on discharge from hospital, best swallow, last visit). However, in aged patients, FILS scores worsened during the follow-up period. FEESS also improved significantly after the operations (on discharge from hospital, best swallow). In 7 cases, FEESS worsened during the follow-up period;however, 6 among these cases maintained oral feeding. In patients over 75 years of age, surgical outcomes were unfavorable due to decreased activities in daily living and poor cognitive function. A postoperative rehabilitation and care support plan should be arranged in advance.</p>

Journal

  • Nihon Kikan Shokudoka Gakkai Kaiho

    Nihon Kikan Shokudoka Gakkai Kaiho 67(6), 398-405, 2016

    The Japan Broncho-esophagological Society

Codes

  • NII Article ID (NAID)
    130006881033
  • NII NACSIS-CAT ID (NCID)
    AN00187474
  • Text Lang
    JPN
  • ISSN
    0029-0645
  • NDL Article ID
    027774974
  • NDL Call No.
    Z19-214
  • Data Source
    NDL  J-STAGE 
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