Lindeman R C
Laryngoscope. 1975 Jan;85(1):157-80. doi: 10.1288/00005537-197501000-00012.
Some unfortunate patients suffer disorders which in one way or another, usually neurologically, severely restrict the larynx in its role as a protector of the lower airway. Aspiration ensues, and unless it can be successfully managed, repeated episodes of a violent pneumonitis may lead to terminal chest problems. In some patients, even the cuffed tracheostomy tubes of new and improved design do not adequately prevent aspiration over an extended time intervel, as evidenced by repeated bouts of aspiration pneumonia despite these cuffed tubes and despite optimal intensive care. For these patients with intractable aspiration, and in whom recovery is expected only after a prolonged period of time, we have suggested a diverting procedure which employs a tracheo-esophageal anastomosis, as an effective yet reversible solution. Such an anastomosis with concomitant tracheostomy allows aspiration of saliva and even food to occur through the malfunctioning larynx but diverts it back into the esophagus through the tracheo-esophageal anastomosis. In normal mongrel dogs we demonstrated that an end-to-side tracheo-esophageal anastomosis is well tolerated and can be performed without damage to the intrinsic larynx or recurrent laryngeal nerves. The tracheo-esophageal lumen remained patent and the anastomosis intact for as long as these animals were observed prior to reconstruction. The reversibility of the tracheo-esophageal anastomosis was demonstrated in these dogs by excising the anastomosis, repairing the esophageal defect, and restoring the continuity of the trachea by end-to-end anastomosis. Vocal cord motion remained intact, the dogs ate normally, and barked once again. A tracheo-esophageal anastomosis was performed in a 60-year-old white female who had suffered lower cranial nerve damage as a result of a large acoustic tumor and the excision thereof. Despite every effort to control aspiration, pneumonitis occurred and became fulminant. The diverting tracheo-esophageal anastomosis was performed with relative ease and was well tolerated by the patient. Aspiration was totally and dependably controlled, and no further chest complications occurred. Her nasogastric feeding tube was removed, and she ate a regular diet with very little difficulty. She gained in strength, became much more alert mentally, and is now taking care of herself in a nursing home. We are following her progress by indirect laryngoscopy and barium swallow examinations and at five months post anastomosis, we are possibly seeing the first signs of lower cranial nerve recovery. We hope that reconstruction and restoration of function will soon be possible.
一些不幸的患者患有各种疾病，这些疾病通常以神经方面的某种方式严重限制喉部作为下呼吸道保护者的功能。继而会发生误吸，除非能够成功处理，否则反复出现的剧烈肺炎可能会导致终末期胸部问题。在一些患者中，即使是设计新颖且经过改进的带套囊气管造口管，在较长时间内也不能充分防止误吸，尽管使用了这些带套囊的管子且给予了最佳的重症监护，但仍反复发生误吸性肺炎就是证明。对于这些患有顽固性误吸且预计仅在长时间后才能康复的患者，我们建议采用一种采用气管 - 食管吻合术的改道手术，作为一种有效且可逆的解决方案。这种伴有气管造口术的吻合术允许唾液甚至食物通过功能失常的喉部发生误吸，但通过气管 - 食管吻合术将其引流回食管。在正常的杂种犬中，我们证明端侧气管 - 食管吻合术耐受性良好，并且可以在不损伤喉固有结构或喉返神经的情况下进行。在重建之前观察这些动物的期间，气管 - 食管腔保持通畅，吻合口完整无损。通过切除吻合口、修复食管缺损并通过端端吻合恢复气管的连续性，在这些犬中证明了气管 - 食管吻合术的可逆性。声带运动保持完整，犬正常进食，并再次吠叫。对一名60岁的白人女性进行了气管 - 食管吻合术，该女性因巨大听神经瘤及其切除而遭受了下颅神经损伤。尽管尽一切努力控制误吸，但仍发生了肺炎并变得严重。改道的气管 - 食管吻合术实施相对容易，患者耐受性良好。误吸得到了完全可靠的控制，并且没有再发生胸部并发症。她的鼻饲管被拔除，她能够正常进食且几乎没有困难。她体力增强，精神更加警觉，现在正在养老院自理。我们通过间接喉镜检查和钡餐检查跟踪她的进展，在吻合术后五个月，我们可能看到了下颅神经恢复的最初迹象。我们希望很快能够进行功能重建和恢复。
