誤嚥防止を目的に喉頭全摘術を施行した4症例

Total Laryngectomy to prevent Aspiration:Report of Four Cases

　はじめに

　不可逆的な嚥下障害やそれに伴う慢性の誤嚥は長期にわたり気道を汚染し，生命をおびやかす存在である。患者は度重なる入退院を課せられ，また患者を介護する家族にとっても負担が大きい。今回，われわれは高度な誤嚥と音声・言語機能障害を有する筋萎縮性側索硬化症（以下ALS）2例，小児脳性麻痺1例，Shy-Drager症候群（以下SDS）1例に対し，誤嚥の防止を目的に喉頭全摘術を施行した。術後経過は良好で早期の退院が可能になり，患者・家族のQuality of Life （以下QOL）は向上した。また，われわれは音声・言語機能の永久喪失などを理由に敬遠されていた喉頭全摘術を見直し，その適応について考察した。

Total laryngectomy, although it produces the most reliable effects in a short period to the patients with neural disorders, was not often been performed because of permanent loss of voice and speech, and of psychological damage due to loss of the larynx. In this study we performed the surgical procedure to prevent aspiration on two patients with amyotro-phic lateral sclerosis, one with cerebral palsy and one with Shy-Drager syndrome who all had serious dysphonia, logopathy and dysphagia. The patients made favorable progress after the operation and were able to be early discharged from the hospital. The quality of life of both the patients and his families improved. If the patient and his family understand the nature of diseases and social envi-ronment surrounding the patient and their psycho-logical problems are resolved, total laryngectomy should be more aggressively performed.