柴田 斉子

OBJECTIVES: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease. METHODS: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up. RESULTS: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up. CONCLUSION: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.

<p>Shibata S, Kagaya H, Tanaka S, Fujii W, Nakagawa K, Matsuo K, Abe K, Ishibashi N, Inamoto Y, Saitoh E. Efficacy of a novel training food based on the process model of feeding for mastication and swallowing: A study among dysphagia patients. Jpn J Compr Rehabil Sci 2017; 8: 82-87.</p><p><b>Objective</b>: Our goal was to verify the validity and safety of chew-swallow managing food (CSM) for dysphagia patients.</p><p><b>Methods</b>: We conducted a study on 14 inpatients diagnosed with dysphagia and judged to be capable of ingesting pureed foods. We instructed each participant to ingest and freely swallow 4-g samples of CSM and pureed food. For each sample, we measured the number of chewing cycles, number of swallows, position of the leading edge of the bolus at the time of swallowing initiation, amount of residue in the oral cavity and pharynx, and occurrence of laryngeal penetration or aspiration.</p><p><b>Results</b>: The number of chewing cycles was significantly higher for the CSM. The position of the leading edge of the bolus at the time of swallowing initiation was primarily in the valleculae for both the CSM and pureed food, and the rate of laryngeal penetration did not significantly differ between the two test foods. There was a high rate of residue on the dorsum of tongue with the CSM and in the valleculae with the pureed food.</p><p><b>Conclusion</b>: The CSM induced chewing in dysphagia patients, and the prevalence of penetration did not differ from the pureed food. Therefore, we concluded that the CSM could be used in chewing exercises with the same level of safety as the pureed food.</p>

健常成人10名を対象として嚥下反射開始前に起こる下咽頭への食塊輸送に対する咀嚼と重力の影響を検討した.バリウム水溶液(液体)10ml,バリウム含有コンビーフ(コンビーフ)8g,液体5ml・コンビーフ4gの混合物(混合)を,座位,よつばい位の2体位で咀嚼させ,ビデオ嚥下造影(VF)を各2回ずつ試行した.その結果,座位において嚥下反射開始直前の食塊の深達度は喉頭蓋谷部Valleculae(VAL)+下咽頭Hypopharynx(HYP)で,混合と他の2食物間で有意差を認めた.更にHYPでは全食物間で有意差を認めた.よつばい位において食物の違いによる深達度の有意差を認めなかった.座位とよつばい位を比較した結果,コンビーフでは体位を変化させても食塊先端位置の分布は殆ど変わらなかった.液体では有意差は認めなかったもののよつばい位においてHYPまで達する頻度が減少傾向にあった.混合では座位に較べてよつばい位でVAL+HYP,HYPに達する率が有意に減少した

咀嚼嚥下の評価法の確立のため,健常成人10名を対象として,4食物条件下で咀嚼が嚥下反射開始前の食塊位置および嚥下時間経過に及ぼす影響を嚥下造影検査を用いて検討した.液体命令嚥下に比し全咀嚼条件で食塊先端位置の中～下咽頭への到達率が高く,食塊進入には咀嚼の存在が一義的に関与し,食物形態はそれを修飾する役割を担うと思われた.混合咀嚼条件では食塊は全例で嚥下前に中～下咽頭へ到達しており,信頼性の高い負荷法といえた.液体を含む咀嚼嚥下では,下咽頭到達が高率で下咽頭通過時間も長く,誤嚥防止の観点から興味深い所見であった.咀嚼嚥下は命令嚥下とは別様式であり「食べる」機能の評価と位置づけられた.