Department of Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA.
LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA.
BMJ Support Palliat Care. 2022 Jun;12(2):235-242. doi: 10.1136/bmjspcare-2020-002626. Epub 2020 Oct 22.
Patients undergoing oesophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires preservation of muscle mass. Swallowing dysfunction puts postoperative patients at risk for aspiration and pneumonia. Modified Barium Swallow Study (MBSS) enables assessment of postoperative swallowing impairments. The current study assessed incidence and risk factors associated with swallowing dysfunction and restricted diet at discharge in patients after oesophagectomy in a high-volume surgical centre.
Patients with an MBSS after oesophagectomy were identified between March 2015 to April 2020 at a high-volume surgical centre. Swallowing was quantitatively evaluated on MBSS with the Rosenbek Penetration-Aspiration Scale (PAS). Muscle loss was evaluated clinically with preoperative hand grip strength (HGS). Univariable and multivariable logistic and linear regression analyses were performed.
129 patients (87% male; median age 66 years) underwent oesophagectomy with postoperative MBSS. Univariate analysis revealed older age, preoperative feeding tube, lower preoperative HGS and discharge to non-home were associated with aspiration or penetration on MBSS. Age and preoperative feeding tube remained as independent predictors in the multivariable analysis. Both univariate and multivariable analyses revealed increased age and preoperative feeding tube were associated with diet restrictions at discharge.
Swallowing dysfunction after oesophagectomy is correlated with increased age and need for preoperative enteral feeding tube placement. Further research is needed to understand the relationship between muscle loss and aspiration with the goal of enabling preoperative physiological optimisation and patient selection.
接受食管切除术的患者常发生营养不良，加之手术的分解代谢作用可导致肌肉质量和功能丧失。安全吞咽需要保留肌肉质量。吞咽功能障碍使术后患者有发生吸入和肺炎的风险。改良钡吞咽研究（MBSS）能够评估术后吞咽障碍。本研究评估了高容量手术中心行食管切除术后患者出院时吞咽功能障碍和限制饮食的发生率及相关危险因素。
在高容量手术中心，于 2015 年 3 月至 2020 年 4 月期间对接受 MBSS 检查的食管切除术后患者进行识别。使用罗森贝克渗透-吸入量表（PAS）对 MBSS 进行定量评估吞咽。术前手握力（HGS）用于临床评估肌肉损失。进行单变量和多变量逻辑回归和线性回归分析。
129 例患者（87%为男性；中位年龄 66 岁）接受了食管切除术，并进行了术后 MBSS 检查。单变量分析显示，MBSS 检查中发生吸入或渗透与年龄较大、术前使用喂养管、术前 HGS 较低和出院至非家庭有关。在多变量分析中，年龄和术前使用喂养管仍然是独立的预测因素。单变量和多变量分析均显示，年龄增加和术前使用喂养管与出院时的饮食限制有关。
食管切除术后吞咽功能障碍与年龄增加和术前需要使用肠内喂养管有关。需要进一步研究以了解肌肉损失与吸入之间的关系，目的是实现术前生理优化和患者选择。
