环状软骨上喉部分切除术后吞咽功能评估的初步研究  

A preliminary study on the assessment of swallowing function after supracricoid partial laryngectomy

作　　者：钟志明[1] 田文栋[1] 刘雄[1] 鲁娟[1] 曾芳芳[1] 陈怀宏[1] 李湘平[1] 

机构地区：[1]南方医科大学南方医院耳鼻咽喉头颈外科,广州510515

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第2期95-100,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的通过客观评估环状软骨上喉部分切除术后的吞咽功能，了解术后半年内患者的吞咽功能恢复情况，探讨适合术后吞咽功能评估的可靠、易行的评估方法。方法采用改良x线吞咽造影（modified barium swallow，MBS）、纤维内镜吞咽检查（fiberoptic endoscopic evaluation of swallowing，FEES）两种方法，结合改良误侵误吸计分量表（modified penetration aspiration scale，MPAS），评估2013年1月至2014年2月期间，在南方医科大学南方医院耳鼻咽喉科采用环状软骨上喉部分切除术的11例喉癌患者术后半年内吞咽功能恢复情况；比较两种评估方法的可行性、可靠性和准确性。结果通过MBS、FEES检查，根据MPAS评分结果，以固体食物、半流食和流食均评为1分作为吞咽功能正常的评估标准，11例患者术后不同时间段吞咽功能恢复正常例数。采用MBS检查：术后16～30d测得正常为2例，术后31～45d为2例，术后46～90d为5例，术后91—180d为6例。采用FEES检查，以上各项时间段分别为3例、4例、6例和8例。以MBS评估作为金标准，固体食物、半流食和流食三类食物MPAS评级均≤4分，而且误吸量少且能咳出，则拔除胃管。11例患者均拔除胃管，拔除胃管平均（元±s）时间为（21．7±9．8）d。Kappa一致性检验显示，MBS、FEES两种方法对固体食物和半流食的评估结果吻合度较强（Kappa值分别为0．802和0．844），对流食评估结果的吻合度一般（Kappa值为0．529）。结论环状软骨上喉部分切除术后半年内患者吞咽功能可恢复正常或基本正常。MBS、FEES两种方法可以客观评估环状软骨上喉部分切除术后患者吞咽功能。FEES因其操作简单，无辐射，耳鼻咽喉医师能自行完成，尤其适用于评估环状软骨上喉部分切除术后患者吞咽功能恢复情况。Objective To investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy. Methods The swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods, the modified barium swallow （MBS） and fiberoptic endoscopic evaluation of swallowing （FEES） , combined with modified penetration aspiration scale （MPAS）. Furthermore, the feasibility, reliability and accuracy of these two methods were compared. Results Eleven patients were enrolled. MPAS equals score 1 for solid food, semiliquid food, and liquid food was defined as a criteria of normal swallowing function. By MBS evaluation, the numbers of patients with normal swallowing function were two cases at day 16 - 30 postoperation, two cases at day 31 - 45 postoperation, five cases at day 46 -90 postoperation, and six cases at day 91 -180 postoperation, respectively. By FEES evaluation, the above numbers were three cases, four cases, six cases and eight cases, respectively. When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food, semiliquid food, and liquid food, the gastric tube could be removed. According to this standard, the gastric tube was removed in all cases, and the mean time was （21.7± 9.8 ） days. A good correlation was obtained between these two methods when evaluating solid and semiliquid food, and the Kappa values were 0. 802 and 0. 844, respectively. However, a little agreement was obtained between these two methods when evaluating liquid food, and the Kappa value was 0. 529. Conclusions Patients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation. Both the MBS and FEES are valuable procedures for evaluating objec

关 键 词：喉肿瘤 癌 鳞状细胞 环状软骨 喉切除术 误吸 吞咽 功能恢复 

分 类 号：R739.65[医药卫生—肿瘤]