気管呼吸(受喉剔者)の生体に及ぼす影響に関する臨床的研究(第2報)
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概要
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Lately in Japan, the registration system has been established.Therefore, statistical study of laryngeal cancer cases is now possible.In order to carry out the present study, many interviews of patients were made. Following are the main post-operative complications.1. permanent loss of speech function.2. naarowing of tracheostoma.3. dryness and crust formation in the region of tracheo-cutaneous junction and the upper tracheal area. 4. diminished of smell sense.5. abnormal taste sense.6. tendency to have frequent common colds.7. increased amount of sputum and occasional coughs.8. potential danger and inconvenience due to the location of newly created tracheal opening in the neck.9. shortness of breath.These post-operative complications beside No.1 were investigated on totally laryngectomized patients and the following reports were made.(1) Temperature on the mucosal surface of trachea and bronchi:Totally laryngectomized people must breath through the newly created opening in their neck. Generally speaking, the temperature on the mucosal surface is lower than normal and not stable.In addition, quick adjustment seems to be necessary to the sudden changes of enviromental temperature.(2) Histo-pathological study on tracheal and bronchial wall tissue.On autopsy, consecutive sections were made from tracheal and bronchial tissue of totally laryngectomized patients.Complete epithelial degener-ation, hyaline-like hyperplasia of basilar membrane and cell infiltration with fibrous proliferation took place in the upper portion of the trachea and carina where the changes of temperature were greater in degree.These histological changes correspond to the duration of tracheal respiration after surgery.(3) The usage of stoma cover on totally lar-yngectomized patients.In general, the tracheal opening incovered by 4 sheets of gauze (so-called apron) in order to protect the respiration. This stoma cover is effe-ctive in regulating surface temperature on tracheal and bronchial mucosa.In order to evaluate possible disturbances by using this stoma cover, pneumotachography was carried out which revealed no significant effects in function.(4) Smell sense:Smell test is carried out by intravenous inje-ction of Alinamin (B1 preparation), smell bottle and positive pressure nebulizer. All 7 cases show total loss of smell sense or highly reduced smell sense.(5) Taste sense :It seems to be difficult to summarize the con-dition of taste sense only by the conventional tests because taste disturbance is more complicated and delicate in nature. However, it is clear that 4 out of 5 show remarkable disturbance of taste sense.(6) Enlargement of tracheal opening:Narrowing of tracheal opening is not a common complication. Slight narrowing brings uncomforta-ble feeling but highly narrowed opening results in difficulty in breathing.In order to reduce this difficulty, partial removal of anterior portion of tracheal rings is performed.This operation shwos relatively good results.
- 社団法人 日本耳鼻咽喉科学会の論文