초록접수 현황
| 16F-296 | 구연 발표 |
Management of Patients with Bilateral Vocal Cord Paralysis following Esophagectomy
Hong-Kyu Lee¹, Jong Ho Cho¹, Hong-Kwan Kim¹, Yong Soo Choi¹, Jae Ill Zo¹, Kwhanmien Kim², Young Mog Shim¹
¹Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, ²Department of Thoracic Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
Background : Recurrent laryngeal nerve paralysis (RNLP) after esophagectomy is a common complication and associated with pneumonia. However, it has been reported in rare series of esophagectomy patients in regard to bilateral vocal cord paralysis. The aim of our study is to investigate the clinical significance of patients who had bilateral vocal cord paralysis (VCP) following esophagectomy.
Methods : Retrospectively, we reviewed the patients who underwent esophagectomy at the single center institute from 1994 to 2014. Among these, patients who had bilateral vocal cord paralysis were included in this study.
Results : A total of 2347 patients who underwent esophagectomy were reviewed and RLNP occurred in 209 (8.9%) patients. Among these, 6.8%(25/209) was found as bilateral vocal cord paralysis by using laryngoscopy after esophagectomy. The surgical procedures were 3-field operation (N=11), 3-hole operation (n=6), Ivor lewis operation(n=5), and others (N=3). During the postoperative managements, only 7 patients (28%) requiered tracheostomy. Two had in-hospital mortality due to pneumonia and ARDS. The other 23 patients were able to discharge from hospital. The mean postoperative hospital staying was mean 33.8 days (range,13-157), and the mean ICU staying period was 27.7 days (range, 2-140). Four patients (16%) discharged with enteral feeding using jejunostomy with N.P.O, and 19 patients (76%) were able to discharge home with oral feeding after aggressive rehabilitation and education.
Conclusion : Bilateral vocal cord paralysis following esophagectomy was rare, but it required great attention to prevent severe respiratory complications. However, only several patients requires tracheostomy and majority of patients were able to discharge home with oral feeding after aggressive training, even though patients suffered from bilateral RNLP. Feeding education and respiratory rehabilitation are critical for the management of these patients.
Methods : Retrospectively, we reviewed the patients who underwent esophagectomy at the single center institute from 1994 to 2014. Among these, patients who had bilateral vocal cord paralysis were included in this study.
Results : A total of 2347 patients who underwent esophagectomy were reviewed and RLNP occurred in 209 (8.9%) patients. Among these, 6.8%(25/209) was found as bilateral vocal cord paralysis by using laryngoscopy after esophagectomy. The surgical procedures were 3-field operation (N=11), 3-hole operation (n=6), Ivor lewis operation(n=5), and others (N=3). During the postoperative managements, only 7 patients (28%) requiered tracheostomy. Two had in-hospital mortality due to pneumonia and ARDS. The other 23 patients were able to discharge from hospital. The mean postoperative hospital staying was mean 33.8 days (range,13-157), and the mean ICU staying period was 27.7 days (range, 2-140). Four patients (16%) discharged with enteral feeding using jejunostomy with N.P.O, and 19 patients (76%) were able to discharge home with oral feeding after aggressive rehabilitation and education.
Conclusion : Bilateral vocal cord paralysis following esophagectomy was rare, but it required great attention to prevent severe respiratory complications. However, only several patients requires tracheostomy and majority of patients were able to discharge home with oral feeding after aggressive training, even though patients suffered from bilateral RNLP. Feeding education and respiratory rehabilitation are critical for the management of these patients.
책임저자: Yong Mog Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Hong-Kyu Lee, E-mail : hk0402.lee@samsung.com