对放疗后的头颈部鳞状细胞癌进行电刺激以改善口干症。
Electrical stimulation of post-irradiated head and neck squamous cell carcinoma to improve xerostomia.
作者信息
Pattani Kavita M, McDuffie Chad M, Morgan Matthew, Armstrong Cynthia, Nathan Cherie-Ann O
机构信息
Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, USA.
出版信息
J La State Med Soc. 2010 Jan-Feb;162(1):21-5.
OBJECTIVE
We observed a significant improvement in the complaints of dysphagia in patients with head and neck cancer who had received noninvasive neuromuscular electrical stimulation (E-stim) of their pharyngeal muscles. We wanted to determine if the improvement in dysphagia was a result of decreased complaints of xerostomia and increased saliva production, since one of our first patients being treated with E-stim noticed a significant improvement in xerostomia.
STUDY DESIGN
Prospective trial to determine the effects of E-stim by evaluating saliva production and dysphagia questionnaires instituted by our speech pathologists on head and neck cancer patients that had received radiotherapy (XRT) and were to undergo E-stim for dysphagia.
METHODS
Prior to the initiation of E-stim and one to two months after E-stim, saliva samples were collected and patients were asked to answer a Dysphagia and Xerostomia Index Questionnaire. All patients received E-stim two to four months after completing XRT. Patients received three E-stim treatments per week for a total of one to two months. Four electrodes were placed along anterior neck over pharyngeal muscles. E-stim was initiated using four to 30mA at 80-100 pulse-widths.
RESULTS
Five patients that received either postoperative radiation therapy or concomitant chemoradiotherapy had been treated with E-stim. All five patients noticed a significant improvement in dysphagia. Five out of five patients noticed a definite increase in saliva production with symptoms of decreased intake of water with meals, sleeping longer hours at night, and increased moistness of lips.
CONCLUSION
E-stim therapy appears to be an effective and approved treatment for dysphagia. Our study shows that it may also be beneficial for xerostomia in the post-irradiated head and neck cancer patients.
SIGNIFICANCE
To determine if E-stim will benefit the previously irradiated patient with dysphagia and xerostomia.
目的
我们观察到接受咽肌无创神经肌肉电刺激（E刺激）的头颈癌患者吞咽困难症状有显著改善。我们想确定吞咽困难的改善是否是由于口干症状减轻和唾液分泌增加所致，因为我们首批接受E刺激治疗的患者之一注意到口干症状有显著改善。
研究设计
前瞻性试验，通过评估由我们的言语病理学家制定的唾液分泌和吞咽困难问卷，来确定E刺激对接受过放射治疗（XRT）并将接受E刺激治疗吞咽困难的头颈癌患者的影响。
方法
在开始E刺激之前以及E刺激后一到两个月，收集唾液样本，并要求患者回答吞咽困难和口干指数问卷。所有患者在完成XRT后两到四个月接受E刺激。患者每周接受三次E刺激治疗，共一到两个月。四个电极沿颈部前方放置在咽肌上。使用4至30毫安、80至100脉宽启动E刺激。
结果
五名接受过术后放射治疗或同步放化疗的患者接受了E刺激治疗。所有五名患者的吞咽困难均有显著改善。五名患者中有五名注意到唾液分泌明显增加，伴有进餐时饮水量减少、夜间睡眠时间延长和嘴唇湿润度增加的症状。
结论
E刺激疗法似乎是一种治疗吞咽困难的有效且经认可的疗法。我们的研究表明，它对放疗后的头颈癌患者的口干也可能有益。
意义
确定E刺激是否会使先前接受过放疗且有吞咽困难和口干的患者受益。
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