喉頭気管分離術を行った誤嚥性肺炎11症例の検討

Laryngotracheal separation in patients with repetitive aspiration pneumonia―A clinical study of 11 cases

I．はじめに

　保存的治療で改善しない難治性の誤嚥性肺炎に対してさまざまな誤嚥防止術が施行されている^1）。誤嚥防止術は術後に発声機能を喪失するという欠点があるが，難治性の肺炎を防止し，家族の介助を軽減させ，経口摂取や在宅管理が可能となりうるなど，多くの利点も存在する^1,2）。なかでも最近は形態上喉頭を温存し，理論的には発声機能の再獲得も可能な喉頭気管分離術を行う例が増加している^2～4）。

　今回われわれは喉頭気管分離術を行った難治性の誤嚥性肺炎患者11例を経験したので，文献的考察を加えて報告する。

　We studied the effectiveness of laryngotracheal separation in 11 patients with repetitive aspiration pneumonia. The patients were 10 males and a female, 3-55 years of age with an average of 18.5 years. Their underlying diseases were cerebral palsy, hypoxic ischemic encephalopathy, leukodystrophy, microcephaly, subacute sclerosing panencephalitis, Sanfilippo syndrome, and cerebral hemorrhage. Aspiration pneumonia was completely cured, and the frequency of suctioning sputum was lowered postoperatively. Transoral ingestion and home care were achieved in 3 and 6 patients, respectively. There were no fatal complications. Although laryngotracheal separation sacrifices phonatory functions, this surgery improves patients' prognosis, and is also beneficial to their family and caregivers.