Evaluación funcional de deglución-aspiración en pacientes sometidos a laringectomía subtotal supracricoidea con cricohioidoepiglotopexia
| Autor: | Oscar Omar Mateos-Aguilar, José Francisco Gallegos-Hernández, José Alberto Abrego, Alma Lilia Ortiz-Maldonado, Pablo Pichardo-Romero, María Elba Díaz-Guzmán |
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| Rok vydání: | 2018 |
| Předmět: |
Gynecology
medicine.medical_specialty business.industry medicine.medical_treatment Hyoid Bone Respiratory Aspiration Locally advanced Laryngectomy General Medicine Epiglottis Cricoid Cartilage Deglutition Carcinoma Squamous Cell medicine Humans In patient Deglutition Disorders business Laryngeal Neoplasms |
| Zdroj: | Gaceta Médica de México. 154 |
| ISSN: | 0016-3813 |
| DOI: | 10.24875/gmm.18003936 |
| Popis: | espanolIntroduccion: La laringectomia subtotal supracricoidea asociada con cricohioidoepiglotopexia es la tecnica quirurgica conservadora mas eficiente para preservar las funciones laringeas de los pacientes con carcinoma localmente avanzado de la laringe. La complicacion mas temida de esta intervencion es la aspiracion en el momento de la deglucion y la neumonia secundaria; existen diversas formas de evaluar la aspiracion y el grado de esta. Presentamos una novedosa forma de identificar incluso pequenas cantidades de aspiracion traqueobronquial. Metodo: Se incluyeron pacientes sometidos a laringectomia subtotal y cricohioidoepiglotopexia por cancer laringeo; todos evaluados con trago radiactivo posoperatorio. Con base en la sintomatologia y resultado del gammagramma se decidio prolongar el tiempo de alimentacion por sonda. Resultados: Se incluyeron 37 pacientes, cuatro habian recibido radioterapia; la tasa de aspiracion fue de 29.7 %; 50 % de los pacientes que habian recibido radioterapia presento aspiracion y 18 % de los pacientes con aspiracion requirio prolongacion del tiempo de alimentacion por sonda nasogastrica; ninguno necesito laringectomia total por aspiracion que no permitiera la deglucion. Conclusiones: La evaluacion posoperatoria de pacientes sometidos a laringectomia subtotal con trago radiactivo permite identificar liquido aspirado al arbol bronquial, incluso en cantidades minimas, y planear el momento para iniciar la deglucion. EnglishIntroduction: Supracricoid subtotal laryngectomy associated with cricohyoidoepiglottopexy is the most efficient conservative surgical technique to preserve laryngeal functions in patients with locally advanced carcinoma of the larynx. The most feared complication of this intervention is aspiration at the moment of swallowing and secondary pneumonia; there are several ways to evaluate aspiration and its degree. We present a novel form to identify even small amounts of tracheobronchial aspiration. Method: Patients undergoing subtotal laryngectomy and cricohyoidoepiglottopexy due to laryngeal cancer were included; all of them were postoperatively assessed with radioactive-swallow. Based on the symptoms and the scintigraphy result, prolonging the feeding time by nasogastric tube was decided. Results: Thirty-seven patients were included; 4 of them had received radiotherapy; aspiration rate was 29.7 %; 50 % of patients who had received radiation had aspiration; 18 % of subjects with tracheobronchial aspiration required prolongation of feeding time by nasogastric tube, none required total laryngectomy for aspiration that hindered swallowing. Conclusions: Postoperative evaluation of patients undergoing subtotal laryngectomy with radioactive-swallow, allows to identify even minimal amounts of fluid aspirated into the bronchial tree and to plan the moment for swallowing to be started. |
| Databáze: | OpenAIRE |
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