経口摂取能力の再獲得にバルーン訓練法と化学刺激が有用であった喉頭全摘出術後の1例

Case report on the effectiveness of balloon-guided rehabilitation and chemical stimulation in the reacquisition of swallowing movements after total laryngectomy

　喉頭全摘出術後に嚥下不能を呈した脳血管障害例を経験した．本症例は術後の食道括約機能が残存しており，経口摂取に必要な食道入口部の開大と食道通過は困難であった．そこで，喉頭全摘出術後に残存した食道入口部の括約機能に対して，知覚刺激の入力に伴う嚥下反射の惹起(以下，嚥下反射の誘発)を目的としたバルーン訓練法を実施した．その結果，輪状咽頭部から下咽頭付近でのバルーン拡張にて嚥下反射が誘発できるようになり，嚥下造影(VF)での嚥下動態の確認と嚥下直接訓練の開始が可能となった．また，嚥下直接訓練の食品に化学刺激を添加することで嚥下反射の遅延が軽減し，経口摂取能力の再獲得に至った．このことは，バルーン訓練法と化学刺激が術後嚥下反射の誘発刺激として活用できる可能性を示唆するものであった．また，術後の嚥下直接訓練の導入に関しては，永久気管孔や味覚障害を考慮した食品選定と化学刺激の工夫が有用と考えられた．

　We encountered a case of cerebral vascular disturbance in which aglutition developed after total laryngectomy.　In this case, the postoperative esophageal sphincter function remained intact, but the dilation of the esophageal inlet and esophageal transit, which are necessary for oral ingestion, were compromised.　Therefore, for the remaining esophageal sphincter function, balloon training was conducted in an attempt to enhance the deglutition reflex induced by sensory impulses (hereafter called induction of the deglutition reflex).　As a result, the deglutition reflex was induced by balloon dilation between the cricopharyngeal part and the hypopharynx, and confirmation of the deglutition state using VF and direct deglutition training became possible.　Furthermore, by adding chemical stimulants to the food to facilitate deglutition training, the delay in the deglutition reflex decreased and the patient finally regained oral ingestion function.　It is suggested that the balloon training and chemical stimulation are useful techniques to promote postoperative deglutition reflex.　It is also suggested that when introducing postsurgical direct swallowing training, attention should be given to food selection in consideration of dysgeusia and the presence of permanent tracheostomy, as well as the effective application of chemical stimuli.