Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability
Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability
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DOI：
10.3109/00016489.2015.1067905
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发表时间：
2015-01-01
影响因子：
1.4
通讯作者：
Himi, Tetsuo
中科院分区：
文献类型：
--
作者：
Takano, Kenichi;Kurose, Makoto;Himi, Tetsuo
结论：气管食管分流术（TED）和喉气管分离术（LTS）可以预防重度运动和智力残疾（SMID）患者的吸入性肺炎，并改善其发病率。通过提高住院率和护理需求，可以改善患者及其父母的生活质量。目的：本研究评价了TED和LTS治疗顽固性误吸和SMID患者的临床结局。研究方法：本研究回顾性分析了2008年1月至2015年1月期间在该机构接受TED或LTS的SMID和难治性吸入性肺炎患者。评估吸痰频率、术前和术后住院次数、手术时间和并发症。结果：在研究期间确定了40例患者。手术后，分泌物抽吸频率（从165.0次/天降至33.0次/天）和因吸入性肺炎住院的次数（从5.4次/年降至0.2次/年）显着减少。1例（2.5%）患者发生气管皮肤瘘，2例（5.4%）患者发生气管无名动脉瘘。在后一组中，成功结扎无名动脉并进行血管内栓塞。
Conclusions: Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents. Objectives: This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID. Methods: This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications. Results: Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed.