纤维喉镜吞咽评估在鼻咽癌吞咽障碍手术中的应用  

Application of fiberoptic laryngoscopy to evaluation of swallowing surgery for nasopharyngeal carcinoma with dysphagia

作　　者：张剑利[1] 陈瑞开[1] 邝得斌 庞艺施[1] ZHANG Jian-li;CHEN Rui-kai;KUANG De-bin(Department of Ear,Nose and Throat,Foshan First People's Hospital,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院耳鼻咽喉科

出　　处：《中国实用医药》2019年第35期17-18,共2页China Practical Medicine

基　　金：佛山市科技攻关项目(项目编号：2016AB002171)

摘　　要：目的探讨纤维喉镜吞咽评估在鼻咽癌吞咽障碍手术中的应用。方法 107例主诉为吞咽阻碍且有鼻咽癌放疗史患者,均行纤维喉镜吞咽评估,观察患者误吸情况,误吸患者行颈段食管造瘘术,采用健康调查简表(SF-36)评估接受手术患者术后6、12个月的生理健康、心理健康、社会功能评分,并与术前比较。结果 107例患者均完成纤维喉镜吞咽评估,其中49例(45.79%)存在误吸。49例患者均顺利接受颈段食管造瘘术,顺利出院,并能自行经造瘘口注食,并均能接受造瘘口注食。49例患者肺部感染由术前的28例降至术后的4例。术后6、12个月患者生理健康、心理健康、生理功能及社会功能评分分别为(66.53±12.83)、(61.76±11.59)、(85.36±11.33)、(62.02±14.94)分和(71.05±14.55)、(62.28±10.38)、(84.69±13.04)、(68.15±15.61)分,均优于术前的(48.35±10.64)、(46.61±11.37)、(56.74±11.52)、(33.48±13.29)分,差异均有统计学意义(P<0.05)。结论纤维喉镜吞咽评估可作为鼻咽癌吞咽障碍的评估工具,发现误吸后及时行外科手术治疗,可改善患者生活质量。Objective To discuss the application of fiberoptic laryngoscopy to evaluation of swallowing surgery for nasopharyngeal carcinoma with dysphagia. Methods A total of 107 patients with dysphagia and a history of radiotherapy for nasopharyngeal carcinoma were evaluated by fiberoptic laryngoscope. The situation of aspiration by mistake, and patients with aspiration by mistake underwent cervical esophagostomy. 36-item short-form health survey(SF-36) was used to evaluate the scores of physical health, mental health and social function of the patients after operation at 6 and 12 months after operation, and compared with those before operation. Results All the 107 patients completed the swallowing evaluation under laryngoscope, 49 cases of(45.79%) had aspiration by mistake. All of the 49 patients were successfully treated with cervical esophagostomy and discharged smoothly. All patients were accepted and able to self-feed through the fistula. The pulmonary infection of 49 patients decreased from 28 cases before operation to 4 cases after operation. At 6 and 12 months after operation, the physical health, mental health, social function score were(66.53±12.83),(61.76±11.59),(85.36±11.33),(62.02±14.94)points, and(71.05±14.55),(62.28±10.38),(84.69±13.04),(68.15± 15.61) points, which was better than(48.35±10.64),(46.61±11.37),(56.74±11.52),(33.48±13.29) points before operation, and their difference was statistically significant(P<0.05). Conclusion Swallowing evaluation by fiberoptic laryngoscopy can be used to evaluate the dysphagia of nasopharyngeal carcinoma, and the quality of life of the patients can be improved by surgical treatment in time.

关 键 词：鼻咽癌 吞咽障碍 纤维喉镜 手术 

分 类 号：R73[医药卫生—肿瘤]