Modified laryngotracheal separation for intractable aspiration pneumonia in patients with nasopharyngeal carcinoma treated by radiotherapy
Modified laryngotracheal separation for intractable aspiration pneumonia in patients with nasopharyngeal carcinoma treated by radiotherapy
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改良喉气管分离术治疗鼻咽癌放疗后顽固性吸入性肺炎
DOI：
10.1016/j.anl.2012.10.002
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发表时间：
2013-06-01
影响因子：
1.7
通讯作者：
Su, Zhenzhong
中科院分区：
文献类型：
--
作者：
Lei, Wenbin;Chai, Liping;Su, Zhenzhong
目的：治疗后鼻咽癌患者难治性吸入性肺炎（PNC）是一种可怕的并发症，但在临床实践中尚未引起足够重视。本院采用改良喉气管分离术（MLTS）治疗上述患者，并对其手术效果进行评价。患者与方法：对我院收治的9例PNC合并难治性吸入性肺炎进行回顾性分析。所有病例均诊断为下颅神经麻痹。经积极抗感染、神经保护、针灸、营养支持、鼻胃喂养、气管切开术等一系列治疗后，吸入性肺炎仍未得到有效预防或控制。最终，所有患者均接受改良喉气管分离（MLTS）手术。评估手术疗效。结果：所有患者术后吸入性肺炎均得到有效控制，6个月后体重增加6 kg以上，营养状况、吞咽功能及生活质量均有改善。结论：鼻咽癌患者放疗后难治性吸入性肺炎可能由下颅神经麻痹引起，可能与放射场重叠有关。改良喉气管分离是消除PNC难治性误吸的有效方法。尽管手术可能是可逆的，但应该仔细选择合适的患者。2012爱思唯尔爱尔兰有限公司版权所有。
Objectives: Intractable aspiration pneumonia in patients with postradiotherapeutic nasopharyngeal carcinoma (PNC) is a formidable complication, but has not attracted enough attention in clinical practice. Modified laryngotracheal separation (MLTS) was applied for these patients in our hospital, the surgical effects of which were assessed.Patients and methods: Retrospective analysis of 9 PNC cases complicated by intractable aspiration pneumonia in our hospital was carried out. All cases were diagnosed as lower cranial nerve palsy. Their aspiration pneumonia was not effectively prevented or controlled after a series of previous treatments, including active anti-infectives, neurotrophy, acupuncture, nutrition support, nasogastric feeding and tracheotomy. Ultimately all of them received modified laryngotracheal separation (MLTS) surgery. Efficacy of the operation was assessed.Results: In all patients, aspiration pneumonia was effectively controlled after the operation, body weights increased more than 6 kg six months later, and nutrition status, swallowing function and quality of life were all improved.Conclusions: Intractable postradiotherapeutic aspiration pneumonia in patients with nasopharyngeal carcinoma was possibly caused by lower cranial nerve palsy, which might be related to radiation fields overlapped. Modified laryngotracheal separation is effective in eliminating intractable aspiration in PNC. Suitable patients should be carefully selected although the procedure is potentially reversible. (c) 2012 Elsevier Ireland Ltd. All rights reserved.