Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada.
Laryngoscope. 2013 Jan;123(1):140-5. doi: 10.1002/lary.23505. Epub 2012 Sep 5.
Advanced tongue cancer is a devastating diagnosis with potential for significant morbidity after treatment. This is especially true for patients undergoing total glossectomy with laryngeal preservation (TGLP), free flap reconstruction and adjuvant radiotherapy. The goals of this study were to: 1) determine long-term objective functional and quality of life outcomes, 2) investigate the influence of rehabilitation on functional recovery and 3) determine swallowing ability in patients with TGLP.
Prospective cohort study and systematic review of the literature.
Functional outcomes data were collected from 2000-2010. Outcomes were measured pre- and 12 months post-surgery and included: gastrostomy-tube (G-Tube) rates, swallowing transit times on video fluoroscopic swallowing studies, speech intelligibility and EORTC-H&N 35 quality of life scores. A systematic review of the literature was conducted to determine comprehensive long term G-Tube rates.
Twelve patients were included and eight were still living at 12 months post-surgery. Fifty percent of patients in this study and 24% with systematic review used G-Tubes at 1 year post-surgery. Patients who could swallow did not aspirate, but more than doubled swallowing transit times. Spoken sentence intelligibility averaged 66% and mean quality of life scores improved 8.9 points 12 months post-surgery. Patients who attended >80% of swallowing and speech rehabilitation sessions demonstrated superior swallowing and speech functional outcomes.
Although a potentially morbid treatment, TGLP and free flap reconstruction can provide good swallowing and speech outcomes as well as meaningful long-term quality of life. Regular attendance of rehabilitation sessions is imperative to optimize functional outcomes.
晚期舌癌治疗后可能会导致严重的发病率，是一种毁灭性的诊断。对于接受全舌切除术伴喉保留（TGLP）、游离皮瓣重建和辅助放疗的患者尤其如此。本研究的目的是：1）确定长期的客观功能和生活质量结果，2）研究康复对功能恢复的影响，3）确定 TGLP 患者的吞咽能力。
前瞻性队列研究和文献系统评价。
从 2000 年至 2010 年收集功能结果数据。在手术前和手术后 12 个月测量结果，包括：胃造口管（G-管）使用率、视频荧光透视吞咽研究中的吞咽通过时间、言语清晰度和 EORTC-H&N 35 生活质量评分。对文献进行系统评价，以确定综合长期 G-管使用率。
本研究纳入了 12 名患者，其中 8 名患者在手术后 12 个月仍存活。本研究中 50%的患者和系统评价中的 24%患者在手术后 1 年使用 G-管。能够吞咽的患者没有发生误吸，但吞咽通过时间增加了一倍以上。口语句子的清晰度平均为 66%，手术后 12 个月生活质量评分平均提高了 8.9 分。参加>80%吞咽和言语康复治疗的患者表现出更好的吞咽和言语功能结果。
尽管 TGLP 和游离皮瓣重建是一种潜在的病态治疗方法，但它可以提供良好的吞咽和言语功能结果以及有意义的长期生活质量。定期参加康复治疗对优化功能结果至关重要。
