喉癌患者环状软骨上喉部分切除术后吞咽功能评估方法的研究  

Evaluation of swallowing function in patients with laryngeal cancer after partial supraclavicular laryngectomy

作　　者：李新龙 杨昌国 Li Xinlong;Yang Changguo(Department of Otorhinolaryngology Head and Neck Surgery,Xi'an Changan Hospital,Shaanxi Xi'an 710016,China)

机构地区：[1]西安市长安医院耳鼻咽喉头颈外科

出　　处：《现代肿瘤医学》2019年第18期3226-3229,共4页Journal of Modern Oncology

摘　　要：目的:分析喉癌患者环状软骨上喉部分切除术后6个月吞咽功能恢复情况及纤维内镜吞咽检查(FEES)、改良X线吞咽造影(MBS)和改良误侵误吸计分量表(MPAS)的评估价值。方法:回顾性分析本院2016年1月至2017年12月收治的55例喉癌患者的临床资料,评估患者术后6个月吞咽功能的恢复情况,并采用Kappa检验分析FEES与MBS两种评估方法的一致性。结果:经FEES和MBS检查,依据患者的MPAS评分结果,吞咽功能正常的评估标准为流食、半流食和固体食物均评为1分,记录55例患者术后不同时间段吞咽功能恢复正常的情况。经FEES检查:术后0.5~1个月吞咽功能正常14例,术后1~1.5个月正常21例,术后1.5~3个月正常31例,术后3~6个月正常42例;经MBS检查:术后0.5~1个月吞咽功能正常9例,术后1~1.5个月正常11例,术后1.5~3个月正常26例,术后3~6个月正常32例。经Kappa一致性检验结果发现,FEES与MBS两种评估方法对流食评估结果的一致性一般(Kappa=0.54),而对半流食与固体食物评估结果的一致性较强(Kappa=0. 85、0. 82)。以MBS检查结果为金标准,拔除胃管的指征为:流食、半流食和固体食物的MPAS评分均≤4级,误吸量少且可咳出。55例患者均可拔除胃管,拔除胃管的平均时间为(20. 95±6. 14) d。结论:喉癌患者在环状软骨上喉部分切除术后6个月的吞咽功能可恢复正常或基本正常,且FEES和MBS两种检查方法对患者术后吞咽功能恢复情况具有良好的评估价值,其中FEES检查具有无辐射、操作简便等特点,临床医师可自行完成,更适用于评估喉癌患者环状软骨上喉部分切除术后吞咽功能的恢复情况。Objective:To analyze the recovery of swallowing function at 6 months after supracricoid partial laryngectomy for laryngeal carcinoma and the evaluation value of fiberoptic endoscopic evaluation of swallowing(FEES),modified barium swallow(MBS) and modified penetration aspiration scale(MPAS).Methods:The clinical data of 55 patients with laryngeal carcinoma treated in our hospital from January 2016 to December 2017 were analyzed retrospectively.The recovery of the swallowing function of the patients after 6 months of operation was evaluated,and Kappa test was used to analyze the consistency between the two assessment methods of FEES and MBS.Results:On the basis of FEES and MBS examination,according to the results of the patients’ MPAS scores,the criteria for the assessment of normal swallowing function were 1 point for feeding,semi feeding and solid feeds,and 55 cases were restored to normal swallowing function at different time periods after operation.FEES examination showed 14 cases of normal swallowing function in 0.5~1 months after operation,21 normal cases in 1~1.5 months after operation,31 cases of normal 1.5~3 months after operation,42 cases in 3~6 months after operation.MBS examination showed 9 cases of normal swallowing function after operation,11 cases of normal 1~1.5 months after operation,26 cases in 1.5~3 months after operation,32 cases in 3~6 months after operation.The Kappa consistency test results showed that the two evaluation methods of FEES and MBS were in general(Kappa=0.54) for the results of the assessment of the flow of food, while the consistency of the results of semi feeding and solid food assessment was stronger(Kappa=0.85,0.82).Taking the MBS results as the gold standard,the indications for gastric tubation showed that the MPAS scores of liquid food,semi liquid diet and solid food were all ≤ grade 4,with less aspiration and coughing.The gastric tube was removed in 55 patients and the average time for removal of gastric tube was(20.95±6.14)d.Conclusion:6 months after supracricoid part

关 键 词：喉癌 环状软骨上喉部分切除术 吞咽功能 纤维内镜吞咽检查 改良X线吞咽造影 改良误侵误吸计分量表 

分 类 号：R739.65[医药卫生—肿瘤]