Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation in neurologically impaired children

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• 作者：Izumi Chida^a ; ^b ; Koichi Tamura^a ; Shin-ichi Nakagawa^a ; ^b ; Masahiro Ando^a ; ^b ; Emi Kuno^c ; Hiroshi Hoshikawa^c ; Nozomu Mori^c ; Noriaki Takeda^a ; ^{takeda@clin.med.tokushima-u.ac.jp}
• 关键词：Tracheoesophageal diversion ; Laryngotracheal separation ; Trumpet-shaped tracheotomy ; Intractable aspiration ; Neurologically impaired children
• 刊名：Auris Nasus Larynx
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：40
• 期：4
• 页码：383-387
• 全文大小：847 K

文摘

Objective

Outcomes of tracheoesophageal diversion and laryngotracheal separation were evaluated in 15 neurologically impaired children treated for intractable aspiration.

Methods

A retrospective analysis of the hospital records was carried out in 15 consecutive pediatric patients who underwent either tracheoesophageal diversion or laryngotracheal separation with trumpet-shaped tracheotomy from 1999 to 2006 in Kagawa Children's Hospital.

Results

The number of hospital admissions for aspiration pneumonia after surgery was significantly decreased in 6 patients who were cared for at home. The parent-reported number of secretion suctioning was decreased after surgery especially in patients with pre-operative tracheotomy or intubation. Four patients fed through naso-gastric tube progressed with oral diet post-operatively, whereas 3 patients who had pre-operative tracheotomy developed temporary post-operative tracheocutaneous fistula that was managed by local wound care.

Conclusion

It is suggested that tracheoesophageal diversion and laryngotracheal separation decrease the morbidity of pediatric patients and improve their quality of life and that of their parents. It is suggested that the risk of developing post-operative fistula is higher in pediatric patients with than without pre-operative tracheotomy.