Ben-David Kfir, Fullerton Amy, Rossidis Georgios, Michel Michael, Thomas Ryan, Sarosi George, White Jeff, Giordano Christopher, Hochwald Steven
Mount Sinai Medical Center, Miami Beach, FL, USA.
Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
J Gastrointest Surg. 2015 Oct;19(10):1748-52. doi: 10.1007/s11605-015-2889-x. Epub 2015 Jul 23.
Pneumonia and tracheal aspiration remain problematic following esophagectomy. We hypothesized that the incidence of postesophagectomy pneumonia occurs in part because of swallowing dysfunction and more importantly silent tracheobronchial aspiration. Therefore, we instituted a routine prospective formal swallowing evaluation to determine if the aspiration rate and its associated morbidity can be decreased by early identification of patients with silent or vocal aspiration.
Patients undergoing minimally invasive McKeown esophagectomy and receiving neoadjuvant chemoradiotherapy (NACR) were prospectively enrolled between December 2013 to January 2015. A standardized cineradiography observation utilizing the Rosenbek penetration-aspiration (RPA) scale was used to rule out anastomotic leak and/or aspiration.
Of 27 patients evaluated, twelve patients were noted to have silent (n = 8) or vocal (cough n = 4) aspiration of thin liquid (n = 8) or nectar-thick consistency (n = 4) on their initial study. Three patients were noted to have an anastomotic leak and vocal aspiration on their initial study. Eight of the nine patients who aspirated but did not have an anastomotic leak on their initial study had a repeat RPA study prior to discharge showing improvement from the initial study. Six patients (22 %) had vocal cord paresis and clinical hoarseness, but only two patients who had clinical diagnosis of pneumonia were noted to have vocal cord paresis and silent aspiration.
Swallowing dysfunction remains a common problem after minimally invasive esophagectomy (MIE) with cervical anastomosis and can be readily identified. Silent aspiration likely contributes to pneumonia after MIE.
食管癌切除术后，肺炎和气管误吸仍然是难题。我们推测，食管癌切除术后肺炎的发生部分是由于吞咽功能障碍，更重要的是隐匿性气管支气管误吸。因此，我们开展了一项常规前瞻性正式吞咽评估，以确定能否通过早期识别隐匿性或有声误吸患者来降低误吸率及其相关发病率。
2013年12月至2015年1月期间前瞻性纳入接受微创McKeown食管癌切除术并接受新辅助放化疗（NACR）的患者。采用标准化的动态X线观察，利用Rosenbek渗透-误吸（RPA）量表排除吻合口漏和/或误吸。
在评估的27例患者中，12例患者在初始检查时被发现存在隐匿性（n = 8）或有声（咳嗽，n = 4）误吸，误吸物为稀液体（n = 8）或花蜜样稠度（n = 4）。3例患者在初始检查时被发现存在吻合口漏和有声误吸。9例初始检查时误吸但无吻合口漏的患者中有8例在出院前进行了重复RPA检查，结果显示较初始检查有所改善。6例患者（22%）存在声带麻痹和临床声音嘶哑，但仅2例临床诊断为肺炎的患者被发现存在声带麻痹和隐匿性误吸。
吞咽功能障碍仍然是微创食管癌切除术（MIE）并颈部吻合术后的常见问题，且易于识别。隐匿性误吸可能是MIE术后肺炎的原因之一。
