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

评估头颈癌患者术后吞咽障碍和功能

基本信息

批准号：
19591988
负责人：
HIGO Ryuzaburo
金额：
$ 3.16万
依托单位：
Saitama Medical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2007
资助国家：
日本
起止时间：
2007 至 2010
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-19591988/
关键词：
頭頸部癌嚥下機能嚥下圧測定手術 Videofluorography 嚥下障害頭頸部腫瘍 VF

项目摘要

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

目的：接受肿瘤切除和重建的头颈癌患者在手术后经常出现吞咽障碍。吞咽障碍通常通过荧光影像 (VF) 进行评估；然而，这种方法提供的定性分析较差。我们研究了测压法在获得头颈癌切除和重建术后患者吞咽功能定量数据方面的有用性，这可能使我们能够开发出恢复吞咽功能的新重建方法。方法：我们采用 VF 和测压法相结合的方式研究接受肿瘤切除和重建的头颈癌患者的术后吞咽功能。 VF检查同时测量口咽部吞咽压、下咽部吞咽压和上食管括约肌（UES）松弛时间。结果与讨论：下颌骨部分切除而不重建骨段缺损对口咽部吞咽压有负面影响。下咽吞咽压正常，除非切除区域涉及下咽。 VF 和测压相结合显示，下颌骨部分切除会导致喉部抬高紊乱，而未接受骨段重建的患者咽部吞咽压力会降低。舌头，包括舌根，应置于封闭空间内，以免咽部吞咽压力释放。在口咽癌患者中，VF检查中咽分期的结果与口咽吞咽压力结果有很好的相关性，但下咽吞咽压力和UES松弛与VF检查结果没有相关性。口咽和下咽吞咽压力均下降的患者在术后一年仍限制流质饮食，而表现出下咽吞咽压力的患者可以在术后不久口服软食或正常饮食。因此，即使口咽吞咽压力受到干扰，维持下咽吞咽压力的患者通常也能在术后很快正常进食。我们的研究结合使用 VF 和测压法，表明口咽癌患者维持下咽吞咽功能对于恢复口腔食物摄入非常重要。在下咽癌患者中，我们检查了部分切除下咽后的吞咽功能。保持舌根的功能，从而维持口咽吞咽压力，对于下咽癌患者下咽部分切除术后非常重要。较少的