周術期に嚥下障害を呈した前縦靭帯骨化症の2症例—背景にある心理的問題との関連

Dysphagia with ossification of the anterior longitudinal ligament in the cervical spine during perioperative period: A report of 2 cases with psychological distress as a background factor

　心理的問題が嚥下機能に強く影響を及ぼした前縦靭帯骨化症(OALL)の2症例を報告する．症例1は喉頭蓋の機能が障害される上位型で，OALL切除術後に嚥下機能が悪化した．症例2は下咽頭から食道にかけての通過が障害される下位型で，OALL切除術後に主観的な嚥下困難感が増悪した．両者の術前心理評価で症例1は正常範囲，症例2は抑うつ不安状態が確認されていたが，それが術後の嚥下機能にいかなる影響を及ぼすか予見できなかった．その結果，手術は成功したものの，入院中に期待した通りの嚥下機能の回復は得られなかった．嚥下障害を訴えるOALL患者に対して嚥下リハビリテーションを担当する言語聴覚士は，術前に心理評価を行い，何らかの心理的問題が判明した場合には精神科受診の必要性を医師に提言すること，骨化巣除去後も嚥下機能が一時的に悪化し回復に長期間を要する場合があることを念頭に置いて周術期治療を計画することが望ましい．

　Two patients with ossification of the anterior longitudinal ligament (OALL) in the cervical spine who complained of dysphagia that was strongly affected by psychological distress were presented. The first case was a “superior type” with unsatisfactory epiglottic closure, and his swallowing dysfunction became worse after OALL resection. The second case was an “inferior type” with impaired deglutition due to cricopharyngeal and esophageal orifice stenosis, and his subjective feeling of swallowing disturbance became worse despite successful OALL resection. Although some psychological problems had been found on preoperative psychological testing, we could not anticipate how strongly they would affect the postoperative recovery of his dysphagia. Consequently, despite successful surgery, the expected recovery was not obtained during hospitalization. Thus, speech-language-hearing therapists in charge of patients with OALL complaining of dysphagia should be aware of the potential impact of psychological factors. First, preoperative psychological distress should be evaluated, and consultation with a psychiatrist should be recommended if any psychological problems are found. Second, a psychological approach should be included in treating postoperative deterioration of dysphagia.