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喉癌非手术治疗(放射治疗/放化疗方案)后的吞咽情况

[Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer].

作者信息

Portas Juliana, Socci Claudia Pereira, Scian Eliana Perissato, Queija Débora Dos Santos, Ferreira Alessandra Sampaio, Dedivitis Rogério Aparecido, Barros Ana Paula Brandão

机构信息

Fonoaudióloga clínica, Oncologia pela Fundação Antonio Prudente, São Paulo, Brasil.

出版信息

Braz J Otorhinolaryngol. 2011 Jan-Feb;77(1):96-101. doi: 10.1590/S1808-86942011000100016.

Abstract

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30%) underwent radiation therapy, and 14 patients (70%) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. All patients had only an oral diet. Normal swallowing was present in only 25% of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85%), bolus ejection (60%), oral cavity stasis (55%), changes in the onset of the pharyngeal phase (100%), decreased laryngeal elevation (65%), and hypopharyngeal stasis (80%). Laryngeal penetration was observed in 25% of the cases; 40% presented tracheal aspiration. The grade of penetration/ aspiration was mild in 60% of cases. Aspiration was silent in 35% of patients. Although 75% of patients had dysphagia, only 25% complained of swallowing difficulties. Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

摘要

放射治疗和放化疗方案可导致吞咽困难。仅针对喉肿瘤治疗进行放射治疗和放化疗方案的患者吞咽功能评估。对20例平均年龄62岁的患者进行肿瘤治疗结束时的前瞻性研究。6例患者(30%)接受放射治疗,14例患者(70%)接受联合治疗。治疗与吞咽评估之间的平均时间为8.5个月。进行视频荧光吞咽造影以评估吞咽的准备期、口腔期和咽期。所有患者仅经口进食。仅25%的患者吞咽正常。视频荧光吞咽造影检查发现以下变化:食团形成(85%)、食团排出(60%)、口腔内潴留(55%)、咽期起始改变(100%)、喉提升减弱(65%)和下咽潴留(80%)。25%的病例观察到喉穿透;40%出现气管误吸。60%的病例穿透/误吸程度为轻度。35%的患者误吸无声音。尽管75%的患者有吞咽困难,但只有25%的患者主诉有吞咽困难。接受放射治疗/联合治疗的喉癌患者在所有吞咽阶段都可能出现变化,或者可能无症状。

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