喉咽癌经口视频喉镜手术后吞咽困难的危险因素。
Risk factors for dysphagia after transoral videolaryngoscopic surgery for laryngeal and pharyngeal cancer.
作者信息
Tomifuji Masayuki, Araki Koji, Yamashita Taku, Mizokami Daisuke, Kamide Daisuke, Suzuki Hiroshi, Miyagawa Yoshihiro, Tanaka Shingo, Taniai Shinichi, Shiotani Akihiro
机构信息
Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan.
出版信息
Head Neck. 2016 Feb;38(2):196-201. doi: 10.1002/hed.23866. Epub 2015 May 22.
BACKGROUND
Transoral surgery is gaining attention as a minimally invasive treatment option for laryngeal and pharyngeal cancer. Postoperative swallowing function is satisfactory in most cases, but occasionally dysphagia persists.
METHODS
Swallowing function of 86 patients who underwent transoral videolaryngoscopic surgery (TOVS) for laryngeal and pharyngeal cancers was evaluated by the Functional Outcome Swallowing Scale (FOSS) and risk factors for dysphagia were identified.
RESULTS
FOSS stage was 0 to 1 in 90%, 2 in 5.8%, 3 in 3.5%, and 4 in 1.2% of the patients. Only 1 patient had indication for percutaneous endoscopic gastrostomy (PEG). Univariate analysis revealed that resection of the pyriform sinus (p = .0280) and arytenoid (p = .0139), pulmonary dysfunction (p = .0353), and large mucosal defect (p = .0223) were associated with postoperative dysphagia.
CONCLUSION
Although the rate of PEG dependency is low in transoral surgery, surgeons should mention the risk of postoperative dysphagia when counseling patients preoperatively.
背景
经口手术作为喉癌和下咽癌的一种微创治疗选择正受到关注。大多数情况下术后吞咽功能令人满意，但偶尔吞咽困难会持续存在。
方法
采用功能性吞咽结局量表（FOSS）对86例接受经口视频喉镜手术（TOVS）治疗喉癌和下咽癌的患者的吞咽功能进行评估，并确定吞咽困难的危险因素。
结果
患者中FOSS分级为0至1级的占90%，2级的占5.8%，3级的占3.5%，4级的占1.2%。仅1例患者有经皮内镜下胃造口术（PEG）指征。单因素分析显示，梨状窝切除（p = 0.0280）、杓状软骨切除（p = 0.0139）、肺功能障碍（p = 0.0353）和大面积黏膜缺损（p = 0.0223）与术后吞咽困难相关。
结论
尽管经口手术中PEG依赖率较低，但外科医生在术前咨询患者时应提及术后吞咽困难的风险。
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