慢性严重误吸的手术治疗

目的：探讨不同病因所致慢性严重误吸患者的最佳手术治疗方式。方法：对8例慢性严重误吸患者分别采用3种手术方式治疗；①气管切开术(5例)、颈气管永久性造瘘术(1例)，气管套管佩带气囊，进食时气囊充气以阻止误吸；②会厌瓣缝合术(即喉口闭锁术，1例)；③胃永久性造瘘术(1例)。结果：8例患者均能经口进食，食物的性状种类不受限制，且未发现吸入性肺炎。其中5例带气囊者仅在进食后放气时，略有轻微刺激性咳嗽，1例喉癌行Arslan术式者，仍有较轻误吸现象，以上6例患者堵管时均能发声，可日常交谈；1例采用会厌瓣缝合术患者，术后经口进食已完全杜绝误吸现象；1例行胃永久性造瘘术者，能较好解决进食误吸，无胃反流现象。结论：会厌瓣缝合术(喉口闭锁术)、气管切开术(或颈气管永久性造瘘术)和胃永久性造瘘术3种术式，均是解决慢性误吸的外科治疗方法，可依不同的病因及患者的具体情况选择最佳术式。

Surgical treatment for the chronic severe aspiration

Objective:To find out the best surgical treatment for chronic severe aspiration with different pathogenesis.Method:Eight patients with severe aspiration were treated by 3 surgical methods.Six of 8 cases were perfomed tracheotomy.The cannula had a gasbag and the gasbag was inflated before eating food every time.Epiglottic flap closure for one patient with intractable aspiration.Stomach stomy for the case with tracheoasophageal fistula.Result:There did not found aspiratory pneumonia in all cases after following up for 9 months to 4.5 years. The six cases with tracheotomy could eating normally and their phonation were reserved.Only one case has a slight aspiration. The patient with epiglottic flap closure hadn't aspirated when eating. The stomach stomy could prevent the aspiration in having meal.Conclusion:Tracheotomy, epiglottic flap closure and stomach stomy are all the effective surgical treatment for chronic severe aspiration.Any of 3 surgical methods should be selected according to the etiology, the degree of aspiration and the patient's condition,so as to improve the quality of the patient's life.