Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy
Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy
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DOI：
10.1093/dote/doaa094
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发表时间：
2021-05-01
影响因子：
2.6
通讯作者：
Shimizu, Yasuhiro
中科院分区：
文献类型：
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作者：
Takatsu, Jun;Higaki, Eiji;Shimizu, Yasuhiro
食管切除术后吞咽困难是术后住院时间延长的主要原因。本研究调查了由言语-语言-听力治疗师（SLHT）领导的吞咽干预对术后吞咽困难的影响。我们入组了276例在2015年7月至2018年12月期间接受食管切除术和颈部食管胃吻合术的连续食管癌患者; 109例接受标准治疗（对照组），167例接受吞咽干预治疗（干预组）。干预组在SLHT指导下进行吞咽功能筛查，并根据患者吞咽功能障碍情况进行康复治疗。比较两组患者进食开始时间、进食恢复时间、术后住院时间。检查了276例患者的亚组，以阐明干预的更有效性。干预组的口服摄入开始时间明显更早（POD：11 vs. 8天; P= 0.009）。在亚组分析中，无并发症（POD：18 vs. 14天; P= 0.001）和喉返神经麻痹（RLNP）（POD：30 vs. 21.5天; P= 0.003）患者的吞咽干预也显著缩短了术后住院时间。多变量回归分析确定吞咽干预是无并发症和RLNP患者更早开始口服摄入和更短术后住院时间的重要独立因素。我们提出的吞咽干预有利于食管切除术后更早开始经口进食和排出，特别是在无并发症和RLNP患者中。该计划可能有助于加强手术后的恢复。
Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech-language-hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient's dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient's subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P= 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P= 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P= 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.