長期臥床症例に対する輪状軟骨鉗除を併用する声門閉鎖術

Abstract

The aspiration pneumonia in bedridden patients with cerebrovascular disorders or progressive neural disease is severe and can recur frequently. The cuffed tracheostomy has been commonly used, but it is insufficient to prevent aspiration pneumonia, which makes it difficult to manage the tracheostoma in many cases.We developed a new glottic closure procedure. The laynx was opened via a midline thyrotomy after removing both thyroid and cricoid cartilages to gain a wide field of operation. The horizontal incision was made at the level of the bilateral vocal cords, and this was separated to superior and inferior mucosal flaps and sutured at the midline above and below. The sternohyoid muscle flap was inserted into the open space between superior and inferior closures. In this study, five cases with tracheal cannulas were treated by this method under local anesthesia.All cases achieved complete inhibition of aspiration without the dehiscence of the closure sites or postoperative infection, and their tracheostomae had been enlarged by the removal of cricoid cartilage. Finally, the large tracheostomae did not require any tracheal cannulas, and the absence of aspiration made it easier to manage the respiratory tract. In conclusion, this procedure produces minimal surgical trauma and is highly useful and safe and can be applied to high risk bedridden patients.