The usefulness of laryngotracheal separation in the treatment of severe motor and intellectual disabilities
The usefulness of laryngotracheal separation in the treatment of severe motor and intellectual disabilities
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DOI：
10.1007/s00383-010-2649-7
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发表时间：
2010-10-01
影响因子：
1.8
通讯作者：
Aoba, Takeshi
中科院分区：
文献类型：
--
作者：
Shima, Hideki;Kitagawa, Hiroaki;Aoba, Takeshi
顽固性误吸是严重运动和智力残疾（SMID）患者的一个危及生命的医学问题。喉气管分离术（LTS）是一种治疗顽固性误吸的外科手术，将上呼吸道与消化道分离。我们对14例SMID患者进行了LTS，以防止难治性误吸，并进行了两种手术。标准的分流手术将上气管连接到食道。改良改道包括关闭近端气管和高位气管造口术，避免气管食管吻合。14例患者行LTS。LTS术前的手术包括4例气管造口术，6例盆底吻合，2例胃造口术。11例患者行标准分流，3例患者行改良分流。无手术并发症。11名患者在LTS后被安全转移到家庭护理。12名患者仍然活着，2名在手术后几个月死亡。一名患者死于原发疾病，另一名死于气管无名动脉瘘（TIAF）。我们最近遇到了一个患TIAF风险很高的病人。LTS是一种有效的手术，可以预防严重运动和智力障碍患者的难治性误吸。标准或改良改道手术的结果是相似的，手术的选择与最初的气管造口部位有关。最严重的并发症是致命的TIAF。
Intractable aspiration is a life-threatening medical problem in patients with severe motor and intellectual disabilities (SMID). Laryngotracheal separation (LTS) is a surgical procedure for the treatment of intractable aspiration which separates the upper respiratory tract from the digestive tract. We performed LTS for 14 patients with SMID to prevent intractable aspiration, performing two types of operation. The standard diversion procedure connected the upper trachea to the esophagus. The modified diversion includes closure of the proximal trachea and a high tracheostomy, avoiding a tracheoesophageal anastomosis. LTS was performed on 14 patients. Operations performed before the LTS included tracheostomy in four patients, fundoplication in six and gastrostomy in two. A standard diversion was performed in 11 patients and a modified diversion in 3. There were no operative complications. Eleven patients were safely transferred to home-care after their LTS. Twelve patients are still alive and two died some months after operation. One patient died from their primary disease and the other died a tracheo-innominate artery fistula (TIAF). We recently experienced a patient who was at high risk of developing a TIAF. LTS is an effective operation, preventing intractable aspiration in patients with severe motor and intellectual disabilities. The results are similar for the standard or modified diversion procedure with the procedure chosen being related to the initial tracheostomy site. The most serious complication is a lethal TIAF.