Watanabe Mio, Shiihara Takashi
No To Hattatsu. 2015 Nov;47(6):439-44.
The present study aimed to evaluate the efficacy of surgical treatment for intractable aspiration in patients with severe motor and intellectual disabilities (SMID) and neuromuscular diseases (NMD).
A retrospective analysis was performed of 20 patients who underwent laryngotracheal separation (LTS) or the tracheal flap method (TFM) between 2003 and 2012 at Gunma Children's Medical Center.
All patients were bedridden and fed either through a naso-gastric or naso-esophageal tube or via a gastric fistula. Of the 20 participants, 60% underwent surgical treatment before 3 years of age. The incidence of aspiration pneumonia decreased after surgery, and 8 of 10 patients, who were previously hospitalized for a long duration, were discharged. The most frequent complications observed were granulation around the tracheostomy stoma and endotracheal granuloma. Two patients presented with a tracheal fistula.
LTS and TFM can be used as treatment modalities for patients with intractable aspiration along with SMID and NMD. In patients with intractable aspiration, after considering their underlying conditions, adaptation and type of operative procedures should be determined.
本研究旨在评估手术治疗对重度运动和智力残疾（SMID）及神经肌肉疾病（NMD）患者顽固性误吸的疗效。
对2003年至2012年间在群马儿童医疗中心接受喉气管分离术（LTS）或气管瓣方法（TFM）的20例患者进行回顾性分析。
所有患者均卧床不起，通过鼻胃管或鼻食管管或经胃瘘进食。20名参与者中，60%在3岁前接受了手术治疗。术后误吸性肺炎的发生率降低，10名之前长期住院的患者中有8名出院。观察到的最常见并发症是气管造口周围肉芽组织和气管内肉芽肿。两名患者出现气管瘘。
LTS和TFM可作为SMID和NMD伴顽固性误吸患者的治疗方式。对于顽固性误吸患者，在考虑其基础病情后，应确定手术的适应性和类型。
