Research into the effectiveness how well the balloon dilatation method causes the desired outcome for cricopharyngeal dysphagia at the chronic stage in cerebrovascular disease

Research into the effectiveness how well the balloon dilatation method causes the desired outcome for cricopharyngeal dysphagia at the chronic stage in cerebrovascular disease

　脳幹部脳血管障害により嚥下中枢のある延髄が障害されると，長期にわたり重篤な咽頭嚥下障害をきたすことがある．治療手技としては外科的手技が多く用いられているが，保存的治療としてバルーンカテーテル訓練法(以下バルーン法)がある．この手技は，機械的に上食道括約筋部(UES)を拡張することで咽頭通過を改善する方法で，本邦でも報告されるようになってきている．本稿では，自然治癒の影響がほとんど期待できない，発症6か月以上を経過した慢性期脳血管障害による球麻痺嚥下患者18名に対してバルーン法を行い，その効果を訓練導入前後，4週間の時点の摂食レベルにより比較した．また，訓練開始時のバルーン法の即時効果の有無を評価し，摂食状態の改善と関連性を検討した．その結果，バルーン法導入前に比べ，導入後では有意に改善がみられたほか，即時効果と摂食状態の改善の間には相関がみられた．自然治癒の影響の低い慢性期嚥下障害患者においてバルーン法の効果が明らかになったことにより，保存的治療の1つとして，バルーン法を用いることの有用性が示唆された．

　When cerebrovascular disorders affect the medulla oblongata of the brain stem, where the swallowing center is present, severe pharyngeal dysphagia may occur and persist for a long period.　Surgery such as cricopharyngeal myotomy is commonly performed;however, the balloon dilatation training method (balloon method) is employed as a conservative therapy.　This procedure which has been studied in Japan, improves pharyngeal passage by mechanically dilating the upper esophageal sphincter (UES).　In this study, we employed the balloon method in 18 patients with cricopharyngeal dysphagia associated with chronic cerebrovascular disorders who had exhibited the symptoms for more than 6 months and had not experienced spontaneous healing.　We examined the effects of this method based by comparing on the ingestion level before training with the level after 4 weeks of training.　We also evaluated the immediate effects of the balloon method at the start of training, and investigated the association with improvement in ingestion.　After 4 weeks of training, the ingestion level significantly improved.　In some cases the balloon method exhibited marked immediate effectiveness, and there was a correlation between the degree of immediate effectiveness and improvement in ingestion.　This procedure as a conservative therapy was useful and effective in patients with chronic dysphagia.