Evaluating postsurgical swallowing disturbance and function in patients with head and neck cance

摘要目的：头颈部肿瘤切除重建术后，患者常会出现吞咽障碍。吞咽障碍通常通过视频荧光成像（VF）进行评估;然而，这种方法提供的定性分析较差。我们研究的有用性，测压在获得定量数据的吞咽功能的头颈部癌症切除和重建后，这可能会让我们导致新的重建方法与恢复的吞咽function.Methods：我们调查了手术后吞咽功能的VF和测压的结合，在头颈部癌症患者，谁接受了肿瘤切除和重建。结果：1.在VF检查的同时，测量口咽吞咽压、下咽吞咽压和食管上括约肌松弛时间（UES）。 关于我们 骨段的CT对口咽吞咽压力有负面影响。下咽吞咽压力正常，除非切除区域涉及下咽。VF和测压的组合显示，下颌骨部分切除导致喉的干扰提升，而咽吞咽压力下降，在那些不接受骨段重建的患者。舌头，包括舌根，应设置在一个封闭的空间，使咽部吞咽压力不会释放。在口咽癌患者中，VF检查中咽部阶段的结果与口咽吞咽压力的结果具有良好的相关性，但下咽吞咽压力和UES松弛与VF检查结果不相关。表现出口咽和下咽吞咽压力降低的患者在手术后一年仍限于流质饮食，而表现出下咽吞咽压力的患者在手术后不久可以口服软的或正常的饮食。因此，保持下咽吞咽压力的患者通常能够在手术后不久正常进食，即使口咽吞咽压力受到干扰。我们的研究，同时使用VF和测压，表明口咽癌患者下咽吞咽功能的维持对口腔进食的恢复很重要。在下咽癌患者中，我们检查了下咽部分切除后的吞咽功能。下咽癌患者下咽部分切除术后，保持舌根功能，维持口咽部吞咽压力，是治疗下咽癌的重要手段。少

Objectives : Head and neck cancer patients who undergo tumor resection and reconstruction often exhibit swallowing disturbance after surgery. Swallowing disturbance is usually evaluated by videofluorography (VF) ; however, this method provides an inferior qualitative analysis. We examined the usefulness of manometry in obtaining quantitative data on swallowing function in patients after head and neck cancer resection and reconstruction, which may allow for us to lead to new reconstruction methods with recovery of swallowing function.Methods : We investigated postsurgical swallowing function using a combination of VF and manometry in patients with head and neck cancer, who underwent tumor resection and reconstruction. Oropharyngeal swallowing pressure, hypopharyngeal swallowing pressure, and relaxation time of upper esophageal sphincer (UES) were measured at the same time as the VF examination.Results and discussion : Partial resection of the mandible without reconstruction for the defe … More ct of the bony segment had a negative effect upon oropharyngeal swallowing pressure. Hypopharyngeal swallowing pressure was normal unless the resection area involved the hypopharynx. A combination of VF and manometry revealed that mandibular bone partial resection resulted in disturbed elevation of the larynx while pharyngeal swallowing pressure decreases in those patients who do not undergo bony segment reconstruction. The tongue, including the base of the tongue, should be set in a closed space so that pharyngeal swallowing pressure does not release. In patients with oropharyngeal cancer patients, findings from the pharyngeal stage in the VF examination were well correlated to the results of oropharyngeal swallowing pressure, but hypopharyngeal swallowing pressure and UES relaxation were not correlated to the results of the VF examination. Patients who exhibited a decrease in both oropharyngeal and hypopharyngeal swallowing pressure were still restricted to a liquid diet a year after surgery, while patients who exhibited hypopharyngeal swallowing pressure could orally ingest a soft or normal diet soon after surgery. Thus patients who maintained hypopharyngeal swallowing pressure generally were able to eat normally soon after surgery, even if the oropharyngeal swallowing pressure was disturbed. Our study, using VF and manometry together, suggested that maintenance of hypopharyngeal swallowing function in patients with oropharyngeal cancer is important in the restoration of oral food intake. In patients with hypopharyngeal cancer patiens, we examined swallowing function after partial resection of the hypopharynx. To keep function of the tongue base, which resulted in maintaining oropharyngeal swallowing pressure, is important for hypopharyngeal cancer patiens after partial resection of the hypopharynx. Less