Fujita H, Hirano M, Kakegawa T, Yamana H, Tanaka S
First Department of Surgery, Kurume University School of Medicine, Japan.
Jpn J Surg. 1991 Nov;21(6):687-92. doi: 10.1007/BF02471056.
Severe aspiration following esophageal reconstruction is often very difficult to treat while preserving the larynx. However, we have successfully adopted a modified surgical procedure previously employed for aspiration caused by neurological diseases or head and neck cancer surgery. We report herein the use of this modified procedure against aspiration in 2 cases following esophagectomy. In the first case, a combination of cricopharyngeal myotomy, infrahyoid myotomy and laryngeal pull-up, with approximation of the thyroid cartilage against the hyoid bone and that of the hyoid bone against the mandible, were performed simultaneously with the primary esophagectomy. In the second case, cricopharyngeal myotomy, infrahyoid myotomy, laryngeal pull-up and infrafold silicone injection were performed three months after the primary operation. Good results were achieved in both cases. Thus, for any case at risk of aspiration after esophagectomy or for any case with severe aspiration following esophagectomy that does not respond to swallow therapy, these operative rehabilitation procedures should be performed before laryngectomy is considered.
食管重建术后的严重误吸在保留喉部的情况下往往很难治疗。然而，我们成功采用了一种先前用于治疗由神经系统疾病或头颈癌手术引起的误吸的改良手术方法。在此，我们报告该改良手术方法在2例食管切除术后误吸病例中的应用。第一例中，在初次食管切除术的同时，进行了环咽肌切开术、舌骨下肌切开术和喉上提术，并使甲状软骨与舌骨、舌骨与下颌骨相互靠近。第二例中，在初次手术后三个月进行了环咽肌切开术、舌骨下肌切开术、喉上提术和下咽皱襞硅胶注射。两例均取得了良好效果。因此，对于任何食管切除术后有误吸风险的病例，或任何食管切除术后严重误吸且吞咽治疗无效的病例，在考虑行喉切除术之前，均应进行这些手术康复程序。
