Kimura Eiko, Tomifuji Masayuki, Uno Kosuke, Taniai Shinichi, Araki Koji, Shiotani Akihiro
Department of Otolaryngology, Japan Self-Defense Force Sapporo Hospital; Department of Otolaryngology Head-Neck Surgery, National Defense Medical College.
Department of Otolaryngology Head-Neck Surgery, National Defense Medical College.
Auris Nasus Larynx. 2023 Jun;50(3):374-382. doi: 10.1016/j.anl.2022.08.005. Epub 2022 Sep 6.
Transoral surgery preserves good swallowing function in most cases, however, postoperative dysphagia sometimes leads to fatal complication such as aspiration pneumonia. We investigated the chronological changes in swallowing function have not been revealed relationship with dysphagia. The primary aim of this study was to reveal the mechanism of dysphagia following transoral surgery by analyzing chronological videofluorography (VF) findings. Moreover, the secondary aim of this study was to evaluate the relationship between mechanism of dysphagia and risk factors of patients to clarify the risk for dysphagia lead to prevention of postoperative complications.
22 patients who underwent transoral videolaryngoscopic surgery (TOVS) for either supraglottic or hypopharyngeal cancer were evaluated swallowing function. We performed VF during the preoperative, postoperative acute, and stable phases and investigated the chronological changes in the VF findings. The following parameters were evaluated by VF: horizontal distance of laryngeal movement, vertical distance of laryngeal elevation, laryngeal elevation delay time (LEDT), Bolus Residue Scale (BRS) scores, and Penetration Aspiration Scale (PAS) scores. Additionally, we evaluated risk factors for postoperative aspiration by investigating relationships between preoperative VF parameters, age of patients, history of radiation therapy, resection area, tumor (T) stage, postoperative Numeric Rating Scale (NRS), and PAS and BRS scores.
The median time at which oral feeding was resumed in this study was 9 (2-200) days. The patients who had postoperative acute PAS scores of 4 and above exhibited delays in resuming oral ingestion after surgery. TOVS did not impair laryngeal elevation and LEDT; however, the BRS and PAS scores temporarily worsened in the acute phase compared to the preoperative scores. These scores almost recovered to their preoperative states in the stable phase, and both the BRS and PAS scores worsened and recovered concurrently. Patients who exhibited poor vertical distance in laryngeal elevation as observed via preoperative VF or who had histories of radiation therapy had worse PAS scores in postoperative acute phase VF. Patients with broad resection areas had worse BRS scores in postoperative acute phase VF.
TOVS didn't impair the function of laryngeal elevation and elicitation of the swallowing reflex whereas pharyngeal bolus clearance, laryngeal penetration, and aspiration temporarily deteriorated concurrently but eventually almost recovered to their baseline values. Patients with histories of radiotherapy, poor laryngeal elevation, and broad resection areas are at the risk of postoperative dysphagia after TOVS. Patients with these risk factors need appropriate evaluation before resuming postoperative oral intake.
在大多数情况下，经口手术能保留良好的吞咽功能，然而，术后吞咽困难有时会导致诸如吸入性肺炎等致命并发症。我们研究了吞咽功能的时间变化，但尚未揭示其与吞咽困难的关系。本研究的主要目的是通过分析时间顺序的视频荧光造影（VF）结果来揭示经口手术后吞咽困难的机制。此外，本研究的次要目的是评估吞咽困难机制与患者风险因素之间的关系，以明确吞咽困难的风险，从而预防术后并发症。
对22例因声门上或下咽癌接受经口视频喉镜手术（TOVS）的患者进行吞咽功能评估。我们在术前、术后急性期和稳定期进行VF检查，并研究VF结果的时间变化。通过VF评估以下参数：喉部运动的水平距离、喉部抬高的垂直距离、喉部抬高延迟时间（LEDT）、团块残留量表（BRS）评分和渗透误吸量表（PAS）评分。此外，我们通过研究术前VF参数、患者年龄、放疗史、切除区域、肿瘤（T）分期、术后数字评定量表（NRS）以及PAS和BRS评分之间的关系，评估术后误吸的风险因素。
本研究中恢复经口进食的中位时间为9（2 - 200）天。术后急性期PAS评分≥4分的患者术后恢复经口摄入延迟。TOVS并未损害喉部抬高和LEDT；然而，与术前评分相比，急性期BRS和PAS评分暂时恶化。这些评分在稳定期几乎恢复到术前状态，且BRS和PAS评分同时恶化和恢复。术前VF观察到喉部抬高垂直距离差或有放疗史的患者，术后急性期VF的PAS评分更差。切除区域广的患者术后急性期VF的BRS评分更差。
TOVS并未损害喉部抬高功能和吞咽反射的诱发，而咽部团块清除、喉部穿透和误吸同时暂时恶化，但最终几乎恢复到基线值。有放疗史、喉部抬高差和切除区域广的患者在TOVS术后有发生吞咽困难的风险。有这些风险因素的患者在术后恢复经口摄入前需要进行适当评估。
