Suzuki Hideaki, Hiraki Nobuaki, Murakami Chie, Suzuki Seiko, Takada Akiko, Ohbuchi Toyoaki, Shibata Minori, Hashida Koichi, Shimono Masayuki
Department of Otorhinolaryngology, University of Occupational and Environmental Health, Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan.
Eur Arch Otorhinolaryngol. 2009 Aug;266(8):1279-83. doi: 10.1007/s00405-009-0942-7. Epub 2009 Mar 13.
Laryngotracheal separation is a simple and reliable operation for the treatment of patients with repetitive and intractable aspiration; however, it is apprehended that pooling in the tracheal blind pouch may cause postoperative complications. In the present study, we examined drainage of the blind pouch created by laryngotracheal separation. Fourteen patients aged 3-63 years with repetitive aspiration pneumonia underwent laryngotracheal separation by the modified Lindeman procedure. A barium swallow was performed 10-30 days after surgery. X-rays of the lateral view of the neck were taken at 6 and 24 h after the swallow, and then every 24 h until the contrast medium cleared. The contrast medium in the blind pouch cleared within 24 h in nine patients. In the remaining five, the clearance time was < or =48 and < or =72 h in two patients each, and 96 h in one patient. The clearance time in patients aged under 20 years was < or =24 h, while middle-aged to elderly patients showed prolonged clearance time. No late complications of the blind pouch, such as infections, were observed. The potential risk of complications caused by pooling in the tracheal blind pouch in laryngotracheal separation is prevented presumably due to the slow but continuous turnover of pooling material. This result supports the validity and usefulness of laryngotracheal separation for the treatment of intractable aspiration.
喉气管分离术是治疗反复性和顽固性误吸患者的一种简单且可靠的手术；然而，人们担心气管盲袋内的积液可能会导致术后并发症。在本研究中，我们检查了喉气管分离术所形成的盲袋的引流情况。14例年龄在3至63岁之间、患有反复性吸入性肺炎的患者接受了改良Lindeman手术进行喉气管分离。术后10至30天进行了吞咽钡剂检查。吞咽后6小时和24小时拍摄颈部侧位X线片，然后每24小时拍摄一次，直至造影剂清除。9例患者盲袋内的造影剂在24小时内清除。其余5例中，2例患者的清除时间分别≤48小时和≤72小时，1例患者的清除时间为96小时。20岁以下患者的清除时间≤24小时，而中年至老年患者的清除时间延长。未观察到盲袋的晚期并发症，如感染。喉气管分离术中气管盲袋内积液引起并发症的潜在风险可能由于积液物质缓慢但持续的更新而得以预防。这一结果支持了喉气管分离术治疗顽固性误吸的有效性和实用性。
