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半舌切除术联合喉悬吊术后吞咽功能良好。

Favourable swallowing outcomes after subtotal glossectomy with laryngeal suspension.

机构信息

Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

出版信息

Int J Oral Maxillofac Surg. 2024 Mar;53(3):191-198. doi: 10.1016/j.ijom.2023.07.002. Epub 2023 Jul 27.

Abstract

Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017-2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005-2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life.

摘要

根治性或近全舌切除术治疗晚期舌癌会对吞咽功能产生不利影响。本回顾性研究的目的是分析术后吞咽结局,并确定这些患者的理想重建方法。回顾性分析了 2005 年至 2019 年在本研究机构行半舌切除术的舌癌患者的临床和吞咽数据。共 101 例患者的数据可供分析。最常用的重建方法是游离腹直肌肌皮瓣(69 例)。出院时和 1 年后需要依赖饲管的患者比例分别为 11.1%和 9.4%。在研究期间,对 39 例(38.6%)患者进行了喉悬吊术和/或环咽肌切开术,其中 25 例手术是在 2017 年以后进行的。与 2005-2016 年治疗的患者相比,2017-2019 年治疗的患者能够更好地接受稀薄液体(P<0.001)和体重减轻更少(P=0.015)。对未行喉悬吊术和/或环咽肌切开术的 61 例患者进行多变量分析显示,65 岁及以上患者依赖饲管喂养的可能性显著更高(P=0.004)。行半舌切除术联合喉悬吊术可显著改善患者对稀薄液体的摄入,从而改善术后吞咽功能和生活质量。

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