PDF(Pubmed)
Abstract：
BACKGROUND: Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration.
METHODS: Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency.
CONCLUSIONS: In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
METHODS: Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency.
CONCLUSIONS: In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
摘要：
背景：严重的吞咽困难可引起难治性肺炎并导致危及生命的疾病。尽管进行了预防误吸的医疗管理，但仍可能发生难以治疗的误吸。手术干预适用于顽固性抽吸，以防止潜在的危及生命的并发症。自1970年代以来,已经报道了几种防止误吸的手术治疗方法，并引入了各种防误吸手术，但对它们或它们的好处知之甚少。这是对防误吸手术类型的回顾，目的是提高医疗专业人员对预防误吸手术的认识及其临床结果，这将指导顽固性误吸患者的误吸预防手术的选择。
方法：抽吸预防手术可以根据其方法分为三种：去除喉，改变气管的结构，并关闭喉部。去除喉的抽吸预防手术包括全喉和中央部分喉切除术。改变气管结构的抽吸预防手术包括气管食管改道，喉气管分离，和气管皮瓣法。关闭喉的手术可分为声门上式喉闭合，声门关闭喉部,声门下喉部闭合。在50-80％的患者中，吸入性预防手术可以防止误吸并增加口服摄入量。大多数患者在预防误吸手术后失去声带功能；然而，一些接受全喉切除或喉气管分离的患者通过气管食管穿刺和使用语音假体恢复了语音功能。会厌瓣闭合和全喉切除术后，术后缝合失败很常见，但在中央部分喉切除术后很少见。喉气管分离，声门闭合,声门下闭合。此外，防误吸手术通过减少吸吸频率改善患者及其护理人员的生活质量.
结论：在这篇综述中，我们描述了防误吸手术的历史和发展。医疗专业人员需要不断提高他们的知识和技能，以根据患者情况进行适当的防误吸手术。
方法：抽吸预防手术可以根据其方法分为三种：去除喉，改变气管的结构，并关闭喉部。去除喉的抽吸预防手术包括全喉和中央部分喉切除术。改变气管结构的抽吸预防手术包括气管食管改道，喉气管分离，和气管皮瓣法。关闭喉的手术可分为声门上式喉闭合，声门关闭喉部,声门下喉部闭合。在50-80％的患者中，吸入性预防手术可以防止误吸并增加口服摄入量。大多数患者在预防误吸手术后失去声带功能；然而，一些接受全喉切除或喉气管分离的患者通过气管食管穿刺和使用语音假体恢复了语音功能。会厌瓣闭合和全喉切除术后，术后缝合失败很常见，但在中央部分喉切除术后很少见。喉气管分离，声门闭合,声门下闭合。此外，防误吸手术通过减少吸吸频率改善患者及其护理人员的生活质量.
结论：在这篇综述中，我们描述了防误吸手术的历史和发展。医疗专业人员需要不断提高他们的知识和技能，以根据患者情况进行适当的防误吸手术。
