Martin R E, Letsos P, Taves D H, Inculet R I, Johnston H, Preiksaitis H G
Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
Dysphagia. 2001 Winter;16(1):23-31. doi: 10.1007/s004550000044.
Although dysphagia is the predominant symptom of esophageal cancer, the nature of the swallowing deficit remains unclear, particularly regarding an oropharyngeal motor component. The present study examined the oropharyngeal swallow in patients with esophageal cancer before and following transhiatal esophagectomy. Videofluoroscopic data were obtained from ten patients with esophageal cancer before and following transhiatal esophagectomy as they swallowed 2-, 5-, and 10-cc aliquots of liquid and puree, and 0.5 and 1 tsp of solid. Each swallow was rated on 36 parameters by three independent judges. Swallow-related hyoid bone movement, computed from digitized segments of the videofluoroscopic data, was compared pre- and postsurgically. All patients showed at least mild abnormality of the oropharyngeal swallow preoperatively. Abnormalities involved all stages of swallowing in nine of the ten patients; however, the oral preparatory/oral stage was relatively more impaired than the pharyngeal stage in the majority of patients. Postsurgically, all patients exhibited at least a mild oropharyngeal swallowing impairment. New or increased postoperative deficits involved the pharyngeal stage of swallowing, whereas oral stage abnormalities were generally improved or unchanged following surgery. Swallow-related hyoid kinematics were highly variable both before and following surgery. Anterior hyoid bone excursion was significantly reduced postoperatively in one patient and significantly increased in one patient. Patients with esophageal cancer exhibit oropharyngeal dysphagia, with different profiles of abnormality before and following esophagectomy.
尽管吞咽困难是食管癌的主要症状，但吞咽功能障碍的本质仍不清楚，尤其是口咽运动成分方面。本研究检查了经裂孔食管切除术前、后食管癌患者的口咽吞咽情况。对10例食管癌患者在经裂孔食管切除术前、后吞咽2毫升、5毫升和10毫升液体及果泥，以及0.5茶匙和1茶匙固体食物时进行了视频荧光透视检查。由三名独立的评判员根据36项参数对每次吞咽进行评分。根据视频荧光透视数据的数字化片段计算出的吞咽相关舌骨运动，在手术前后进行了比较。所有患者术前均至少表现出轻度口咽吞咽异常。10名患者中有9名患者的吞咽各阶段均存在异常；然而，在大多数患者中，口腔准备期/口腔期比咽期受损相对更严重。术后，所有患者均至少表现出轻度口咽吞咽功能障碍。术后新出现或加重的功能障碍涉及吞咽的咽期，而口腔期异常在术后通常有所改善或未变。手术前后吞咽相关舌骨运动学变化很大。一名患者术后舌骨向前移动明显减少，一名患者则明显增加。食管癌患者存在口咽吞咽困难，食管切除术前、后的异常表现各不相同。
