食管癌根治性切除术后急性术后阶段口咽吞咽困难的患病率、性质和严重程度。

The prevalence, nature and severity of oropharyngeal dysphagia in the acute post-operative phase following curative resection for esophageal cancer.

作者信息

Hayes Michelle, Gillman Anna, Elliott Jessie A, Donohoe Claire L, Reynolds John V, Regan Julie

机构信息

Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland.

Department of Speech and Language Therapy, St. James' Hospital, Dublin, Ireland.

出版信息

Dis Esophagus. 2025 Jul 3;38(4). doi: 10.1093/dote/doaf054.

DOI:10.1093/dote/doaf054

PMID:40645642

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12253955/

Abstract

BACKGROUND

Oropharyngeal dysphagia and aspiration in the early post-esophagectomy period is rarely studied. This study investigated its prevalence, nature and severity, differences across surgical subgroups, and predictors of risk.

METHODS

A prospective cohort study was conducted (January 2022-January 2024) at the National Esophageal Cancer Centre. Data was collected on post-operative day (POD) 4 or 5. Swallowing evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2(DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS)]. Functional Oral Intake Scale (FOIS) was used to identify oral intake status.

RESULTS

N = 30 (25 males) were recruited, mean age (range) of 65 (46-80y), n = 13 2-stage, n = 8 3-stage, and n = 9 transhiatal resections. At POD 4/5, 60% (18/30) showed signs of aspiration, with no differences across surgical groups (P = 0.114). Dysphagia per the DIGESTv2 was present in 83% (25/30) of patients, with severe dysphagia in 23% (7/30). MBSImP assessment revealed reduced tongue base retraction (82%), pharyngeal residue (100%) and impaired neo-esophageal clearance (100%). Predictors of aspiration were: pre-operative abnormal FOIS (score < 7) (OR = 7.00, 95%CI 1.2-38.4; P = 0.024), and > 65 years (OR = 7.80, 95%CI 1.47-41.6; P = 0.016). Predictors for oropharyngeal dysphagia were: abnormal pre-operative FOIS (score < 7) (OR = 7.42, 95%CI 1.22-45.45; P = 0.029); age > 65 years (OR = 11.00, 95%CI 1.99-58.8; P = 0.006) and neoadjuvant treatment (OR = 7.20, 95%CI 1.08-47.96, P = 0.041).

CONCLUSION

Oropharyngeal dysphagia and aspiration are prevalent in the early period after esophageal cancer surgery. These data should inform an increased input from speech and language specialists in the assessment and management of post-operative patients, and overall caution in the implementation and progression of early per orum intake.

摘要

背景

食管切除术后早期口咽吞咽困难和误吸很少被研究。本研究调查了其患病率、性质和严重程度、不同手术亚组之间的差异以及风险预测因素。

方法

在国家食管癌中心进行了一项前瞻性队列研究（2022年1月至2024年1月）。在术后第4天或第5天收集数据。吞咽评估包括电视荧光吞咽造影检查[吞咽毒性动态成像分级v2（DIGESTv2）、改良钡剂吞咽障碍量表（MBSImP）、渗透-误吸量表（PAS）]。使用功能性经口进食量表（FOIS）确定经口进食状态。

结果

招募了N = 30例患者（25例男性），平均年龄（范围）为65岁（46 - 80岁），13例为2期手术，8例为3期手术，9例为经裂孔切除术。在术后第4/5天，60%（18/30）的患者出现误吸迹象，各手术组之间无差异（P = 0.114）。根据DIGESTv2，83%（25/30）的患者存在吞咽困难，23%（7/30）的患者存在严重吞咽困难。MBSImP评估显示舌根后缩减少（82%）、咽部残留（100%）和新食管清除受损（100%）。误吸的预测因素为：术前FOIS异常（评分<7）（OR = 7.00，95%CI 1.2 - 38.4；P = 0.024），以及年龄>65岁（OR = 7.80，95%CI 1.47 - 41.6；P = 0.016）。口咽吞咽困难的预测因素为：术前FOIS异常（评分<7）（OR = 7.42，95%CI 1.22 - 45.45；P = 0.029）；年龄>65岁（OR = 11.00，95%CI 1.99 - 58.8；P = 0.006）和新辅助治疗（OR = 7.20，95%CI 1.08 - 47.96，P = 0.041）。