Kojima Kazuhiro, Fukushima Takuya, Kurita Daisuke, Matsuoka Aiko, Ishiyama Koshiro, Oguma Junya, Daiko Hiroyuki
Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan.
Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Dysphagia. 2023 Aug;38(4):1147-1155. doi: 10.1007/s00455-022-10541-2. Epub 2022 Dec 1.
Despite the increasing use of minimally invasive esophagectomies, aspiration pneumonia remains the most serious complication. This study clarified the association between perioperative tongue pressure and postoperative aspiration after thoracoscopic-laparoscopic esophagectomy in patients with esophageal cancer. This retrospective, single-center, observational study evaluated data of 216 patients scheduled for thoracoscopic-laparoscopic esophagectomy. Tongue pressure was measured before the procedure and on postoperative day 6; perioperative changes were assessed. Patients were divided into non-aspiration and aspiration groups according to penetration-aspiration scale scores. Hierarchical and stratified logistic regression analyses were performed to identify factors associated with aspiration. Receiver operating characteristic curves were used to assess the cut-off value of perioperative changes in tongue pressure for aspiration. Perioperative changes in tongue pressure (odds ratio 0.92; 95% confidence interval 0.88-0.96, P < 0.001), age (odds ratio 1.07; 95% confidence interval 1.01-1.13, P = 0.013), and postoperative recurrent laryngeal nerve palsy (odds ratio 3.04; 95% confidence interval 1.15-8.03, P = 0.025) were significantly associated with aspiration. The cut-off value of perioperative changes in tongue pressure for postoperative aspiration was - 6.58%. In addition, decreases in tongue pressure were associated with aspiration regardless of recurrent laryngeal nerve palsy and age. The perioperative decrease in tongue pressure, higher age, and postoperative recurrent laryngeal nerve palsy were significant factors strongly associated with aspiration in the acute phase post-esophagectomy. Decreased tongue pressure is the only intervenable predictor of aspiration. Rehabilitation for preventing decreases in tongue pressure may reduce the risk of aspiration.
尽管微创食管切除术的应用越来越广泛，但吸入性肺炎仍然是最严重的并发症。本研究阐明了食管癌患者行胸腹腔镜联合食管切除术后围手术期舌压与术后误吸之间的关联。这项回顾性、单中心观察性研究评估了216例计划行胸腹腔镜联合食管切除术患者的数据。在手术前和术后第6天测量舌压；评估围手术期的变化。根据渗透-误吸量表评分将患者分为无误吸组和误吸组。进行分层和分层逻辑回归分析以确定与误吸相关的因素。采用受试者工作特征曲线评估围手术期舌压变化对误吸的截断值。围手术期舌压变化（比值比0.92；95%置信区间0.88 - 0.96，P < 0.001）、年龄（比值比1.07；95%置信区间1.01 - 1.13，P = 0.013）和术后喉返神经麻痹（比值比3.04；95%置信区间1.15 - 8.03，P = 0.025）与误吸显著相关。术后误吸的围手术期舌压变化截断值为 - 6.58%。此外，无论喉返神经麻痹和年龄如何，舌压降低都与误吸相关。食管切除术后急性期围手术期舌压降低、高龄和术后喉返神经麻痹是与误吸密切相关的重要因素。舌压降低是误吸唯一可干预的预测因素。预防舌压降低的康复治疗可能会降低误吸风险。
