Leder Steven B, Bayar Sancar, Sasaki Clarence T, Salem Ronald R
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520, USA.
J Am Coll Surg. 2007 Oct;205(4):581-5. doi: 10.1016/j.jamcollsurg.2007.05.027.
Pulmonary complications after transhiatal esophagectomy occur commonly and frequently cause severe morbidity and possible mortality. Aspiration, both overt and silent, can also be present with some regularity after this procedure, and it appears intuitive that identification of aspiration with the appropriate measures of avoidance of oral intake and avoidance of oral contrast studies may help reduce the consequences of aspiration pneumonia.
In an attempt to help identify patients at risk for aspiration, we prospectively studied 73 patients who had recently undergone transhiatal esophagectomy using fiberoptic endoscopic evaluation of swallowing (FEES). Evaluation of premature spillage, pharyngeal residue, pooling, penetration, and aspiration was carried out.
Twenty-one percent of patients showed evidence of aspiration and were kept npo, with deferral of oral contrast studies. Of all the potential predictors of aspiration studied, only vocal fold immobility was a notable predictor of aspiration. But 40% of patients who aspirated had normal vocal fold function. Vocal fold immobility was also identified in several patients thought to have completely normal voice quality. There were no complications of FEES. All patients who demonstrated aspiration and all those with vocal fold immobility eventually demonstrated swallowing without aspiration and recovery of cord function.
This study demonstrated the safety and efficacy of FEES in evaluation of laryngeal function in the postoperative setting after transhiatal esophagectomy. A FEES is recommended before the contrast study or oral feeding challenge for objective determination of aspiration risk from pharyngeal or laryngeal pathology. Early determination of aspiration status may reduce or eliminate pulmonary complications.
经胸食管切除术术后肺部并发症很常见，常导致严重发病甚至可能死亡。在该手术后，显性和隐性误吸也会经常出现，直观来看，通过适当措施识别误吸并避免经口摄入和避免口服造影剂检查，可能有助于降低误吸性肺炎的后果。
为了帮助识别有误吸风险的患者，我们前瞻性地研究了73例近期接受经胸食管切除术的患者，采用纤维内镜吞咽功能评估（FEES）。对过早溢出、咽部残留、积聚、穿透和误吸进行了评估。
21%的患者显示有误吸证据，予以禁食，并推迟口服造影剂检查。在所有研究的误吸潜在预测因素中，只有声带运动障碍是误吸的显著预测因素。但40%有误吸的患者声带功能正常。在一些被认为声音质量完全正常的患者中也发现了声带运动障碍。FEES没有并发症。所有显示有误吸的患者以及所有有声带运动障碍的患者最终都表现出无误吸的吞咽和声带功能恢复。
本研究证明了FEES在经胸食管切除术后评估喉功能中的安全性和有效性。建议在进行造影剂检查或经口进食挑战之前进行FEES，以客观确定咽部或喉部病变导致的误吸风险。早期确定误吸状态可能会减少或消除肺部并发症。
