Gerber M E, Gaugler M D, Myer C M, Cotton R T
Department of Pediatric Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio, USA.
Arch Otolaryngol Head Neck Surg. 1996 Dec;122(12):1368-71. doi: 10.1001/archotol.1996.01890240074016.
To assess the efficacy of bilateral submandibular gland excision and bilateral parotid duct ligation in treatment of chronic aspiration in neurologically impaired children.
Retrospective chart review and telephone follow-up interview.
Tertiary care center.
All patients from 1986 through 1994 who underwent bilateral submandibular gland excision and bilateral parotid duct ligation and had evidence of at least 1 episode of aspiration pneumonia in the year prior to undergoing surgery.
Two main outcomes measures were (1) the change in number of hospitalizations for pneumonia and total number of lower respiratory tract infections between 1 year before and 1 year after surgical intervention and (2) telephone assessment of patient outcome with respect to parental satisfaction, effect on quality of life, care requirements, amount of suctioning, and use of voice.
Sixteen patients aged 16 months to 18 years were included. After surgical intervention, there was a significant decrease in the mean (+/-SD) number of pneumonias (2.3 +/- 1.44 before surgery, 0.9 +/- 1.2 after surgery; P < .001) and hospitalizations (1.2 +/- 0.8 before surgery, 0.4 +/- 0.8 after surgery; P < .005). Six patients had a tracheostomy at the time of surgery, and 1 required a tracheostomy 2 years after surgery. No individual required laryngotracheal separation. Eleven families were able to be contacted by telephone. Caretakers reported that in 8 of 11 patients, quality of life was improved and care requirements decreased. Seven patients used voice for at least some degree of communication. Three patients had postoperative complications involving the parotid glands; all resolved after further therapy.
Bilateral submandibular gland excision and bilateral parotid duct ligation reduce the incidence of aspiration pneumonias and hospitalization, and decrease overall care requirements in a select group of neurologically impaired children. Because they are voice sparing, are efficacious, and have a low morbidity, they should be considered before laryngotracheal separation or tracheoesophageal diversion.
评估双侧下颌下腺切除术和双侧腮腺导管结扎术治疗神经功能受损儿童慢性误吸的疗效。
回顾性病历审查和电话随访访谈。
三级医疗中心。
1986年至1994年间所有接受双侧下颌下腺切除术和双侧腮腺导管结扎术且在手术前一年有至少一次吸入性肺炎证据的患者。
两个主要观察指标为：（1）手术干预前1年和手术后1年肺炎住院次数和下呼吸道感染总数的变化；（2）通过电话评估患者结局，包括家长满意度、对生活质量的影响、护理需求、吸痰量和声音使用情况。
纳入16例年龄在16个月至18岁之间的患者。手术干预后，肺炎的平均（±标准差）次数显著减少（术前2.3±1.44次，术后0.9±1.2次；P<.001），住院次数也显著减少（术前1.2±0.8次，术后0.4±0.8次；P<.005）。6例患者在手术时进行了气管切开术，1例在术后2年需要气管切开术。无人需要喉气管分离术。通过电话联系到了11个家庭。护理人员报告称，11例患者中有8例生活质量得到改善，护理需求减少。7例患者至少在一定程度上使用声音进行交流。3例患者术后出现腮腺并发症；经进一步治疗后均痊愈。
双侧下颌下腺切除术和双侧腮腺导管结扎术可降低吸入性肺炎的发生率和住院率，并减少特定神经功能受损儿童群体的总体护理需求。由于它们保留声音、疗效显著且发病率低，在考虑喉气管分离术或气管食管转流术之前应予以考虑。
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