喉部分切除术对患者吞咽相关生存质量的远期影响  

Longterm impact on swallowing quality-of-life after partial laryngectomy

作　　者：严毛晓[1] 林刃舆[1] 陈建福[1] 叶凡[1] 

机构地区：[1]温州医学院附属第一医院耳鼻喉科,325000

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第8期651-656,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：温州市科技局对外科技合作交流项目（H20100075）

摘　　要：目的探讨各种喉部分切除术1年以后对患者吞咽相关生存质量的影响。方法采用吞咽相关生存质量量表（Swallowing quality-of-life questionnaire，SWAL-QOL）香港中文版，对96例喉部分切除术后1年以上患者的生存质量进行调查。按照手术方式分为4组：环状软骨上喉部分切除环舌骨吻合术（supracricoid partial laryngectomy-cricohyoidopexy，SCPL-CHP，以下简称CHP）、环状软骨上喉部分切除环舌骨会厌吻合术（supraericoid partial laryngectomy-cricohyoidoepiglottopexy，SCPL-CHEP，以下简称CHEP）、声门上喉水平部分切除术、喉垂直部分切除术。结果采用多元方差分析，可见喉癌术式对生存质量各维度的总体效应差异具有统计学意义（F=8．5，P〈0．01）；除外疲倦和睡眠2个维度，另外9个维度差异均具有统计学意义（P值均〈0．01）。Bonferroni法两两比较4种术式在这9个维度得分的差异：除了言语交流维度，喉垂直部分切除术组均是近满分表现，CHP、CHEP、喉水平部分切除术组在多个维度得分显著低于喉垂直部分切除术组，差异均有统计学意义（P值均〈0．05）；CHP组在多个维度均为4组中的最低分，差异均有统计学意义（P值均〈0．05）；喉水平部分切除术和CHEP组在除外言语频率的其他维度中差异均无统计学意义（P值均〉0．05）；误咽患者在社会功能等维度得分偏低。结论喉癌术式对患者术后吞咽相关的长期生存质量有显著影响，CHP对吞咽相关生存质量影响最大，喉垂直部分切除术患者吞咽相关生存质量最好。长期误咽对患者的影响是多维的，可导致患者的社会功能退化。Objective To discuss the longterm quality-of-life related to swallowing function after different partial laryngectomy. Methods The worldwide known swallow quality-of-life questionnaire （ SWAL-QOL, Hongkong, Chinese edition） ; was used in this research to evaluate the swallowing QOI, on 96 postoperative patients who underwent different kinds of partial laryngectomy more than one year before. The patients were divided into 4 groups： supracricoid partial laryngectomy-cricohyoidopexy （SCPL-CHP）, supracricoid partial laryngectomy-cricohyoidoepiglottopexy （SCPL-CHEP）, horizontal superagllotic partial laryngectomy （horizontal PL）, and vertical partial laryngeetomy （vertical PL）. Results A one-way MANOVA revealed a significant multivariate （ the 11 scales of SWAL-QOL） main effect for groups （ P 〈 0. 01 ） , and significant univariate main effects were obtained for groups in 9 scales out of 11 （P 〈 0. 01 ）. In all the 9 scales vertical PL group acquired near full scores except the communication scale, and was significantly higher than the other 3 groups in many scales （ P 〈 0. 05 ）. CHP group acquired the worst scores of the 4 groups, showing significant differences in most of the 9 scales （ P 〈 0. 05 ）. No significant difference was found between Horizontal PL and CHEP except in communication （P 〉 0. 05）. Patients with deglutition disorders （choke/cough） had a lower score in the social function scale. Conclusions Swallowing quality- of-life of postoperative patients was deeply influenced even when more than one year had passed after surgery. Some of them felt deeply burdened by deglutition disorder. Patients after CHP proved to have a worst quality of life than the others, while vertical PL the best. The QOL between Horizontal PL and CHEP was shown to be almost the same. The influence over QOL from longterm dysphagia was multi-dimensional, containing the degeneration of social function.

关 键 词：喉切除术 吞咽障碍 生活质量 问卷调查 

分 类 号：R739.65[医药卫生—肿瘤]