舌癌発症10年経過後に嚥下障害が重症化した1症例—バルーン拡張法の有効性

Effectiveness of balloon dilatation in a case of severe dysphagia 10 years after the onset of tongue cancer

　【はじめに】舌癌患者は手術や再発防止治療により嚥下機能面の低下を引き起こし，その後も加齢や廃用の影響により，さらに嚥下機能低下が予想される．今回，舌癌発症から10年後に嚥下機能低下を認め，バルーン拡張法(balloon dilatation：BD)を含む嚥下機能訓練により経口摂取が確立した1症例の経過と考察を報告する．【症例・経過】81歳男性．10年前に舌癌を発症し舌右半側切除，腹直筋皮弁再建術，頸部郭清術，放射線化学療法を実施した．嚥下造影検査上，食道入口部通過障害，誤嚥を認めた．【結果】初回BDで舌骨移動距離の延長，食道入口部径の開大があり，即時効果を認めた．転院時には痰絡みや咽込みの減少，食事時間の短縮を認め，3食経口摂取が確立した．【考察】嚥下機能回復の要因は，BD早期導入による食道入口部開大を契機とした他の嚥下機能訓練との複合的効果と考えられた．

　In tongue cancer patients, swallowing function declines due to surgery and recurrence prevention treatment, and it is expected that swallowing function later declines further due to the effects of aging and disuse. We report the course and discussion of a case in which swallowing function declined 10 years after the onset of tongue cancer. His oral intake was established by swallowing function training including balloon dilatation (BD). The case was an 81-year-old male. He developed tongue cancer 10 years ago and underwent right hemi-lateral resection of the tongue, the reconstruction with rectus abdominis musculocutaneous flap, neck dissection, and radio chemotherapy. On a videofluoroscopic examination of swallowing, obstruction of the passage through the esophageal entrance and aspiration were observed. In the first BD, the movement distance of the hyoid bone was extended and the diameter of the cricopharyngeal area was dilated, and consequent improvements were observed immediately. At the time of transfer to another facility, reduction of sputa and coughs as well as shortened mealtime were observed, and oral intake of 3 meals was established. The recovery of swallowing function was considered to be triggered by dilation of the esophageal entrance by an early introduction of BD and achieved by a combined effect with other swallowing function training.