気管食道瘻発声者における誤嚥防止機構

Abstract

In 1976, primary tracheoesophageal (TE) fistulisation with the membranous part of the trachea was established by Amatsu for the purpose of voice reconstruction following laryngectomy. In 1983, a short procedure against aspiration was added to the original method. It was arranged to obtain sphincter mechanism by looping both esophagus and TE fistula with inferiorly based esophageal muscle flaps obtained from the posterolateral aspect of the esophagus. The rate of aspiration during deglutition has been remarkably improved after this modification.In this study, 4 TE speakers without aspiration were subjected to fluoroscopic examination to clarify the mechanism inhibiting aspiration. All of them had no aspiration with slight infiltration of the contrast medium into the TE fistula in 2 subjects. The contrast medium in the fistula was trapped at the level of the muscular loop. Esophageal dilatation with slight elevation at the upper level was the major finding. From these facts, the mechanism that blocks aspiration was concluded to be the muscular loop constricting the fistula when the esophagus dilates at swallowing.