Goeze Almut, Zaretsky Eugen, Lehner Uta, Wermter Laura, Mayer Miriam, Stuck Boris A, Birk Richard, Neff Andreas, Fisher Ingo, Stöver Timo, Kramer Sabine, Ghanaati Shahram, Sader Robert, Hey Christiane
Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland.
Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland.
Laryngorhinootologie. 2022 Apr;101(4):320-326. doi: 10.1055/a-1528-7584. Epub 2021 Jun 29.
Dysphagia constitutes a frequent post-operative functional impairment in head-and-neck cancer patients. This impairment can result in aspiration/penetration and limitations of oral intake. Therefore, often it requires a therapeutic intervention. In this study, prevalence of post-operative dysphagia and its associations with the tumour stage, localisation, patients' age, and biological sex were analysed for the inpatient treatment setting.
A total of 201 adult head-and-neck cancer patients (mean age 63 years) were analysed prospectively by FEES in two university hospitals in regard to their penetration/aspiration, limitations of oral intake, and need for therapeutic interventions directly after the operative tumour treatment. Additionally, the influence of the same patients' characteristics on these three parameters were analysed by means of univariate and multivariate statistical methods.
Out of 201 patients, 66.7 % needed a therapeutic intervention because of their dysphagia, 57.2 % needed a nasogastral or PEG tube due to limitations of oral intake, 45.3 % had an aspiration. In the latter subgroup, 38.5 % had a silent aspiration. Higher tumour stage, patients' higher age and male sex were shown to be significant influence factors for dysphagia, tumour localisation showed only a marginally significant result.
The study demonstrated a clinical importance and relevance of the consequent and systematic treatment of post-operative dysphagia in head-and-neck cancer patients in the acute care units as a constituent of a modern oncological therapy.
吞咽困难是头颈癌患者常见的术后功能障碍。这种功能障碍可导致误吸/食物渗漏及经口摄入量受限。因此，通常需要进行治疗干预。在本研究中，分析了住院治疗患者术后吞咽困难的发生率及其与肿瘤分期、部位、患者年龄和生物学性别的关系。
在两家大学医院对总共201例成年头颈癌患者（平均年龄63岁）进行前瞻性纤维内镜吞咽功能检查（FEES），评估其食物渗漏/误吸情况、经口摄入量受限情况以及肿瘤手术治疗后直接进行治疗干预的必要性。此外，采用单因素和多因素统计方法分析相同患者特征对这三个参数的影响。
201例患者中，66.7%因吞咽困难需要治疗干预，57.2%因经口摄入量受限需要鼻饲管或经皮内镜下胃造口术（PEG）置管，45.3%存在误吸。在后一组中，38.5%为隐匿性误吸。较高的肿瘤分期、患者较高的年龄和男性被证明是吞咽困难的重要影响因素，肿瘤部位仅显示出边缘性显著结果。
该研究表明，在急性护理病房对头颈癌患者术后吞咽困难进行连贯和系统的治疗具有临床重要性和相关性，是现代肿瘤治疗的组成部分。
