Taniguchi Hiroshige, Matsuo Koichiro, Nakagawa Kazuharu, Furuya Junichi, Kanazawa Manabu, Minakuchi Shunsuke
Department of Dentistry & Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan.
Department of Oral Health Care Science for Community and Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
Clin Nutr ESPEN. 2019 Feb;29:183-188. doi: 10.1016/j.clnesp.2018.10.008. Epub 2018 Nov 2.
Systemic muscle wasting during perioperative periods has a major impact on postoperative morbidity. However, data on oropharyngeal muscle weakness after surgery are scarce. We examined whether maximum tongue pressure (MTP) and hand grip strength (HGS) diminished during the perioperative period without and with oral feeding in patients receiving cancer surgery.
A total of 258 patients undergoing cancer surgery who had visited a hospital dental clinic were prospectively recruited between October 2015 and February 2016. MTP and HGS were measured on the day before and 4 days after surgery. Data on age, sex, tumor location, surgical procedure, and oral feeding status were obtained from patient medical records. We analyzed for differences in the perioperative changes of MTP and HGS according to surgical procedure, oral feeding, and tumor location using ANOVA.
Neither MTP nor HGS differed significantly among tumor locations before surgery. The proportion of patients with an oral diet at 4 days after surgery was 36.7% and 34.5% for upper GI and colorectum groups versus 89.2% and 86.4% for genitourinary and lung groups, respectively. During the perioperative period, MTP decreased more significantly in patients without oral feeding than in those with oral feeding at 4 days after surgery (P < 0.01). HGS was not affected by postoperative oral feeding status. Both MTP and HGS decreased more significantly in the upper gastrointestinal group than in the genitourinary and lung groups (P < 0.05), except for MTP between upper GI and genitourinary groups (P = 0.10).
MTP, but not HGS, diminishes significantly during the perioperative period without oral feeding. As tongue muscle disuse after surgery may adversely impact postoperative oropharyngeal muscle decline, perioperative tongue muscle strengthening exercises may assist in maintaining muscle strength and good oral feeding.
围手术期全身肌肉萎缩对术后发病率有重大影响。然而，关于术后口咽肌无力的数据却很少。我们研究了接受癌症手术的患者在围手术期有无经口进食情况下，最大舌压（MTP）和握力（HGS）是否会降低。
2015年10月至2016年2月期间，前瞻性招募了258例到医院牙科诊所就诊并接受癌症手术的患者。在手术前一天和术后4天测量MTP和HGS。从患者病历中获取年龄、性别、肿瘤位置、手术方式和经口进食状况等数据。我们使用方差分析，根据手术方式、经口进食和肿瘤位置分析MTP和HGS围手术期变化的差异。
术前不同肿瘤位置的MTP和HGS均无显著差异。上消化道和结直肠组术后4天经口进食患者的比例分别为36.7%和34.5%，而泌尿生殖系统和肺部组分别为89.2%和86.4%。围手术期，术后4天未进行经口进食的患者MTP下降比经口进食的患者更显著（P < 0.01）。HGS不受术后经口进食状况的影响。除上消化道组与泌尿生殖系统组之间的MTP（P = 0.10）外，上消化道组的MTP和HGS下降均比泌尿生殖系统和肺部组更显著（P < 0.05）。
在围手术期未进行经口进食时，MTP会显著降低，而HGS不会。由于术后舌肌废用可能对术后口咽肌衰退产生不利影响，围手术期进行舌肌强化锻炼可能有助于维持肌肉力量和良好的经口进食。
