Lörken A, Krampert J, Kau R J, Arnold W
Department of Otorhinolaryngology, Head and Neck Surgery, Technical University, Klinikum rechts der Isar, Munich, Germany.
Dysphagia. 1997 Spring;12(2):79-83. doi: 10.1007/PL00009523.
Patients with hypopharyngeal and cervical esophageal strictures and fistulas caused by advanced malignancy, ingestion of caustic material, or following surgery or radiation therapy often suffer from marked dysphagia. In such cases the implantation of a Montgomery Salivary Bypass Tube (MSBT) can be an effective therapeutic option to bridge the fistulous tract or bypass a stenosis. Being able to eat and drink without the need for intravenous supplementation or nasogastric or gastrostomy tube feeding in general greatly improves the patient's quality of life. Since 1981 we have successfully inserted the MSBT in 44 cases suffering from dysphagia of different etiology. Our experiences with the indications for implantation, insertion techniques, and postoperative results are presented. Three selected cases of progressive dysphagia in which the MSBT is demonstrated to be the treatment of choice are described in more detail. In one case, a tracheoesophageal fistula and in another a stricture of the upper esophageal sphincter (UES) were bypassed so that oral intake of soft food became possible again. The third patient suffered from a disturbance of the esophageal motility after resection of a Hippel-Lindau tumor in the spinal cord and syringe drainage; even swallowing saliva was impeded. After insertion of a MSBT, uncomplicated soft food intake became possible again.
下咽和颈段食管狭窄及瘘管患者，由晚期恶性肿瘤、腐蚀性物质摄入、手术或放疗后引起，常伴有明显吞咽困难。在此类情况下，植入蒙哥马利唾液旁路管（MSBT）可成为一种有效的治疗选择，用于跨越瘘道或绕过狭窄部位。一般来说，能够在无需静脉补充营养或鼻胃管或胃造瘘管喂养的情况下进食和饮水，可极大地改善患者的生活质量。自1981年以来，我们已成功为44例不同病因导致吞咽困难的患者植入了MSBT。本文介绍了我们在植入指征、插入技术及术后结果方面的经验。详细描述了3例渐进性吞咽困难的精选病例，其中MSBT被证明是首选治疗方法。在1例中，绕过了气管食管瘘，在另一例中，绕过了食管上括约肌（UES）狭窄，从而再次实现了软食的经口摄入。第3例患者在脊髓和注射器引流的希佩尔-林道肿瘤切除术后出现食管动力障碍；甚至吞咽唾液也受到阻碍。植入MSBT后，再次实现了无并发症的软食摄入。
