摘要
目的探讨结肠代食管术后所致复杂性吞咽困难的治疗新策略。方法选取结肠代食管术后吻合口狭窄致复杂性吞咽困难患者1例，采用增强气道保护训练、舌压抗阻反馈训练、Masake吞咽训练法、用力吞咽法、VitalStim电刺激对患者进行吞咽功能治疗。治疗前、后，采用临床吞咽功能评估、功能性经口摄食量表（FOIS）、视频吞咽造影检查（VFSS）、高分辨率咽腔压力测定对患者的吞咽功能进行评定。结果FOIS由1级进展至7级，吞咽造影数字化分析显示，治疗前患者的咽腔收缩率为50％，治疗后咽腔收缩率为23％。高分辨率咽腔压力测定显示，患者治疗前腭咽压力峰值为82．8mmHg，治疗后为156．9mmHg；治疗前腭咽收缩持续时间为310ms，治疗后为525ms；治疗前下咽压力峰值为53．7mmHg，治疗后为103．2mmHg；治疗前下咽收缩持续时间390ms，治疗后为1030ms。复查吞咽造影显示患者会厌谷残留减少，吻合口较前明显开放，渗漏消失。患者可完全经口进食，拔除空肠造瘘管。结论对于结肠代食管术后吻合口重度狭窄所致吞咽困难的患者，经扩张治疗无效后，可通过综合吞咽功能训练增加咽部推动力以促进吞咽功能改善。
Objective To explore a new treatment for complicated dysphagia cases caused by esophageal re- placement. Methods Airway protection maneuvers, tongue pressure resistance feedback exercises, Masake＇s swal- lowing exercises and effortful swallowing exercise were applied in treating a patient with complicated dysphagia. The clinical dysphagia evaluations included applying the functional oral intake scale （FOIS） , videofluoroscopy and high- resolution manometry （HRM）. They were used to evaluate the patients＇ swallowing function before and after treat- ment. Results The patient＇s FOIS score increased from level one to level seven. Videofluoroscopy showed that the pharynx constriction rate rose from 23% before the treatment to 50% afterward. The HRM indicated that the average palatopharyngeal pressure peak climbed from 82.8 mmHg before treatment to 156.9 mmI-Ig after, and that the average duration of palatopharyngeal contraction increased from 310 ms to 525 ms. Moreover, the average hypopharynx pres- sure peak rose from 53.7 mmHg to 103.2 mmHg, and the average duration of hypopharynx contraction rose from 390 ms before treatment to 1030 ms after treatment. Swallowing visualization showed that a bolus could normally pass through the anastomotic stoma and that leakage had disappeared. The patient could eat different types of food inde- pendently and the jejuno-stoma tube was removed before discharge. Conclusion For patients with dysphagia caused by anastomotic stric＇ture after esophageal replacement, swallowing function can be improved by increasing the pharyngeal impetus when dilation is not effective.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2015年第12期930-933,共4页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
结肠代食管术
吻合口狭窄
吞咽障碍
康复
Esophageal replacement
Anastomotic stricture
Dysphagia
Rehabilitation
