Kawata Sanshiro, Hiramatsu Yoshihiro, Honke Junko, Murakami Tomohiro, Booka Eisuke, Matsumoto Tomohiro, Morita Yoshifumi, Kikuchi Hirotoshi, Yamauchi Katsuya, Takeuchi Hiroya
Department of Surgery Hamamatsu University School of Medicine Hamamatsu Japan.
Department of Perioperative Functioning Care and Support Hamamatsu University School of Medicine Hamamatsu Japan.
Ann Gastroenterol Surg. 2024 Jun 26;8(6):1026-1035. doi: 10.1002/ags3.12839. eCollection 2024 Nov.
Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post-esophagectomy swallowing function.
We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross-sectional areas (cm) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration-Aspiration Scale (PAS) during video-fluoroscopic swallowing studies performed 7-10 days postoperatively.
The cross-sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, < 0.01: median in males: 3.2 cm, and in females: 2.3 cm). These values were used to define high and low cross-sectional area groups. The cross-sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, = 0.03) and cross-sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, = 0.03). In the multivariate analysis, low cross-sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, = 0.03 and odds ratio = 6.6, = 0.02, respectively).
Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy.
吞咽困难常在食管切除术后出现。颏舌骨肌参与吞咽运动，但其在食管切除患者中的意义尚不清楚。我们研究了术前颏舌骨肌质量与食管切除术后吞咽功能的关系。
我们回顾性分析了114例行食管恶性肿瘤食管切除术及胃代食管重建术的患者。我们使用计算机断层扫描评估术前颏舌骨肌矢状截面积（cm）。将各性别中位数作为临界值。在术后7 - 10天进行的电视透视吞咽研究中，使用渗透-误吸量表（PAS）评估吞咽困难严重程度。
男性的截面积显著大于女性（3.2±0.7 vs. 2.4±0.5，<0.01；男性中位数：3.2 cm，女性中位数：2.3 cm）。这些值用于定义高截面积组和低截面积组。截面积与握力（相关系数（CC）=0.530）和骨骼肌指数（CC =0.541）呈正相关。在电视透视吞咽研究中，有误吸（PAS评分≥6；20%）的患者转甲状腺素蛋白水平（22.4±6.8 vs. 25.4±5.5，=0.03）和截面积（2.6±0.7 vs. 3.2±0.8，<0.01）显著低于无误吸的患者。电视透视研究中有误吸的患者喉返神经麻痹的发生率显著高于无误吸的患者（22% vs. 5%，=0.03）。在多变量分析中，低截面积和喉返神经麻痹均是吞咽研究中误吸的独立危险因素（比值比分别为3.6，=0.03和6.6，=0.02）。
使用颈部计算机断层扫描评估的术前颏舌骨肌质量可预测食管切除术后的吞咽困难。
