Motsch Christiane
Otto-von-Guericke-Universität Magdeburg, Klinik für Hals-, Nasen- and Ohrenheilkunde, Magdeburg, Deutschland.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2005;4:Doc11. Epub 2005 Sep 28.
As diverse as the causes of oropharyngeal dysphagia can be, as broad is the range of potential therapeutical approaches. In the past two decades, methods of plastic-reconstructive surgery, in particular microsurgically revascularised tissue transfer and minimally invasive, endoscopic techniques of every hue have substantially added to the portfolio of reconstructive surgery available for rehabilitating deglutition. Numerically, reconstructing the pharyngolaryngeal tract following resection of squamous-cell carcinomas in the oral cavity, the pharynx and the larynx has been gaining ground, as has functional deglutitive therapy performed to treat posttherapeutical sequelae. Dysphagia and malnutrition are closely interrelated. Every third patient hospitalised in Germany suffers from malnutrition; ENT tumour patients are not excluded. For patients presenting with advancing malnutrition, the mortality, the morbidity and the individual complication rate have all been observed to increase; also a longer duration of stay in hospital has been noted and a lesser individual toleration of treatment, diminished immunocompetence, impaired general physical and psychical condition and, thus, a less favourable prognosis on the whole. Therefore, in oncological patients, the dietotherapy will have to assume a key role in supportive treatment. It is just for patients, who are expected to go through a long process of deglutitive rehabilitation, that enteral nutrition through percutaneous endoscopically controlled gastrostomy (PEG) performed at an early stage can provide useful and efficient support to the therapeutic efforts. Nutrition and oncology are mutually influencing fields where, sooner or later, a change in paradigms will have to take place, i.e. gradually switching from therapy to prevention. While cancer causes malnutrition, feasible changes in feeding and nutrition-associated habits, including habitual drinking and smoking, might lower the incidence of cancer worldwide by 30 to 40% (American Institute of Cancer Research 1999).Esse oportet, ut vivas, non vivere ut edas. / Thou shouldst eat to live, not live to eat.Cicero 106 - 43 B.C.
口咽吞咽困难的病因多种多样，相应地，潜在的治疗方法也层出不穷。在过去二十年中，整形重建手术方法，尤其是显微外科血管化组织移植以及各种微创内镜技术，极大地丰富了用于吞咽功能康复的重建手术方法。从数量上看，口腔、咽和喉鳞状细胞癌切除术后重建咽喉道以及治疗治疗后遗症的功能性吞咽治疗都在不断发展。吞咽困难和营养不良密切相关。在德国，每三名住院患者中就有一名患有营养不良，耳鼻喉肿瘤患者也不例外。对于营养不良状况不断加重的患者，观察发现其死亡率、发病率和个体并发症发生率均有所上升；住院时间也更长，个体对治疗的耐受性降低，免疫能力受损，全身身体和精神状况不佳，总体预后也较差。因此，在肿瘤患者中，饮食疗法在支持治疗中必须发挥关键作用。对于那些预计要经历漫长吞咽康复过程的患者，早期通过经皮内镜下胃造口术（PEG）进行肠内营养可以为治疗提供有益且有效的支持。营养与肿瘤学是相互影响的领域，迟早会发生范式转变，即逐渐从治疗转向预防。虽然癌症会导致营养不良，但在饮食和营养相关习惯方面做出可行改变，包括改变习惯性饮酒和吸烟习惯，可能会使全球癌症发病率降低30%至40%（美国癌症研究学会,1999年）。
你应当为了生活而饮食，而非为了饮食而生活。
西塞罗，公元前106年 - 公元前43年
