舌口底癌術後の誤えん症状改善に間欠的経口食道経管栄養法を併用したえん下訓練が有効であった１例

Abstract

We describe the postoperative course of a patient with carcinoma in the oral floor and the tongue, in whom chronic postoperative aspiration successfully responded to intermittent oro-esophageal (IOE) tube feeding with deglutition training. The patient had a poor swallowing reflex, resulting in an immobile pharynx, although postoperative wound healing progressed normally. Initially, a tracheotomy tube to prevent aspiration and a nasogastric (NG) tube for feeding were provided, but swallowing was not restored. A therapeutic program to stimulate swallowing in the pharyngeal stage was established. The program included deglutition training to avoid aspiration and IOE tube feeding to avoid use of the NG tube. Six weeks after initiation of the program, abnormal aspiration of saliva decreased, and the tracheotomy tube was removed. After 8 weeks, the patient was able to orally insert the IOE tube and to take to the required volume of nutrition. The NG tube was therefore discarded. After 5 months, videofluorography confirmed that the patient could swallow safely without aspiration, showing reflexive movement of the pharynx. This clinical experience suggests that swallowing function might be negatively affected not only by surgical invasion but also by long-term placement of an NG tube and a tracheotomy tube. In patients who have aspiration associated with placement of NG and tracheotomy tubes, deglutition training and IOE tube feeding may help to restore swallowing function.