297 KISEP How I Do It 臨床耳鼻: 臨床耳鼻: 臨床耳鼻: 臨床耳鼻:第10 卷 第2 號 1999 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• J Clinical Otolaryngol 1999;10:297-299 난치성 오연 치료를 위한 Blom-Singer 튜브를 이용한 성문폐쇄술 원자력병원 이비인후-두경부외과 이용식·최진호·이병철 Glottic Closure with Blom-Singer Tube Applied for Intractable Aspiration Yong-Sik Lee, MD, Jin-Ho Choi, MD and Byeong-Cheol Lee, MD Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea - ABSTRACT - Severe aspiration occasionally bring into fatal results. In mildly aspirated cases, supportive therapy or conser- vative operation is sufficient. However, severely aspirated patients need more invasive operation. Although a lot of operative methods have been introduced, choice of operative method is controversial. Especially, extent of operation, post-operarative vocability and reversability must be considered. Authors operate on three pati- ents for intractable aspiration due to both vocal cord palsy with glottic closure with Blom-singer tube insertion, and controlled the aspirations effectively. ( J Clinical Otolaryngol 1999 ; 10 : 297-299) KEY WORDS:Glottic closure·Aspiration·Blom-singer tube. 서 론 오연(기도흡인)은 경우에 따라선 환자에게 있어 치 명적인 결과를 초래할 수 있다. 1)2) 오연이 심하지 않을 경우 대증적 요법이나 보존적인 수술로도 치료가 가능 하지만 심한 경우는 좀더 침습적인 수술이 필요하다. 다 양한 수술법이 개발되어 있지만 그 선택에 있어서는 아 직 논란의 여지가 많다. 특히 수술의 범위, 술후 발성가 능 여부 및 수술의 가역성 여부가 주된 고려사항이라 하 겠다. 양측 성대마비로 지속적인 오연을 보이는 환자에 있어 Blom-Singer 튜브를 이용한 성문폐쇄술(Glottic closure)를 시행하여 만족스런 결과를 얻을 수 있었다. 증 례 증 례 1: 김○○, M/63 98년 4월, 3개월전부터 시작된 연하곤란을 주소로 본 원 내원한 환자는 식도암으로 진단받고, 98년 5월 7일 흉부외과에서 식도절제술 시행받았으며, 이때 양측 반회 신경손상을 입음. 이후 기도개창술 시행하였으나 오연으 로 인한 흡인성 폐렴 지속되어 98년 6월 12일, 성문폐 쇄술 시행하였음. 이후 기관공 협착 있어 98년 9월 15일 기관공 성형술 시행하면서 동시에 Blom-Singer 튜브 삽입술 시행함. 증 례 2: 김○○, F/65 97년 5월 2일, 식도암으로 본원 흉부외과에서 식도 교신저자:이용식, 139-706 서울 노원구 공릉동 215-4 원자력병원 이비인후-두경부외과 전화:(02) 974-2501(Р쏑냙締쏑냃B뜾뿴2255)·뉻 전송:(02) 978-2005 E-mail:[email protected]
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KISEP How I Do It 10 2 1999
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
J Clinical Otolaryngol 1999;;;;10::::297-299
Blom-Singer
Glottic Closure with Blom-Singer Tube Applied for Intractable
Aspiration
Yong-Sik Lee, MD, Jin-Ho Choi, MD and Byeong-Cheol Lee, MD
Department of Otorhinolaryngology-Head and Neck Surgery, Korea
Cancer Center Hospital, Seoul, Korea
---- ABSTRACT ---- Severe aspiration occasionally bring into fatal
results. In mildly aspirated cases, supportive therapy or conser-
vative operation is sufficient. However, severely aspirated
patients need more invasive operation. Although a lot of operative
methods have been introduced, choice of operative method is
controversial. Especially, extent of operation, post-operarative
vocability and reversability must be considered. Authors operate on
three pati- ents for intractable aspiration due to both vocal cord
palsy with glottic closure with Blom-singer tube insertion, and
controlled the aspirations effectively. ((((J Clinical Otolaryngol
1999;10:297-299)))) KEY WORDSGlottic closure·Aspiration·Blom-singer
tube.
.
Blom-Singer
.
.
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Fig. 3. Postoperative endoscopic finding.