CAJ | 학술논문

目的通过客观评估环状软骨上喉部分切除术后的吞咽功能,了解术后半年内患者的吞咽功能恢复情况,探讨适合术后吞咽功能评估的可靠、易行的评估方法.方法采用改良X线吞咽造影(modified barium swallow,MBS)、纤维内镜吞咽检查(fiberoptic endoscopic evaluation of swallowing,FEES)两种方法,结合改良误侵误吸计分量表(modified penetration aspiration scale,MPAS),评估2013年1月至2014年2月期间,在南方医科大学南方医院耳鼻咽喉科采用环状软骨上喉部分切除术的11例喉癌患者术后半年内吞咽功能恢复情况;比较两种评估方法的可行性、可靠性和准确性.结果通过MBS、FEES检查,根据MPAS评分结果,以固体食物、半流食和流食均评为1分作为吞咽功能正常的评估标准,11例患者术后不同时间段吞咽功能恢复正常例数.采用MBS检查:术后16 ～ 30 d测得正常为2例,术后31 ～45 d为2例,术后46 ～ 90 d为5例,术后91 ～ 180 d为6例.采用FEES检查,以上各项时间段分别为3例、4例、6例和8例.以MBS评估作为金标准,固体食物、半流食和流食三类食物MPAS评级均≤4分,而且误吸量少且能咳出,则拔除胃管.11例患者均拔除胃管,拔除胃管平均((x-)±s)时间为(21.7±9.8)d.Kappa一致性检验显示,MBS、FEES两种方法对固体食物和半流食的评估结果吻合度较强(Kappa值分别为0.802和0.844),对流食评估结果的吻合度一般(Kappa值为0.529).结论环状软骨上喉部分切除术后半年内患者吞咽功能可恢复正常或基本正常.MBS、FEES两种方法可以客观评估环状软骨上喉部分切除术后患者吞咽功能.FEES因其操作简单,无辐射,耳鼻咽喉医师能自行完成,尤其适用于评估环状软骨上喉部分切除术后患者吞咽功能恢复情况.
목적 통과객관평고배상연골상후부분절제술후적탄인공능,료해술후반년내환자적탄인공능회복정황,탐토괄합술후탄인공능평고적가고、역행적평고방법.방법 채용개량X선탄인조영(modified barium swallow,MBS)、섬유내경탄인검사(fiberoptic endoscopic evaluation of swallowing,FEES)량충방법,결합개량오침오흡계분량표(modified penetration aspiration scale,MPAS),평고2013년1월지2014년2월기간,재남방의과대학남방의원이비인후과채용배상연골상후부분절제술적11례후암환자술후반년내탄인공능회복정황;비교량충평고방법적가행성、가고성화준학성.결과 통과MBS、FEES검사,근거MPAS평분결과,이고체식물、반류식화류식균평위1분작위탄인공능정상적평고표준,11례환자술후불동시간단탄인공능회복정상례수.채용MBS검사:술후16 ～ 30 d측득정상위2례,술후31 ～45 d위2례,술후46 ～ 90 d위5례,술후91 ～ 180 d위6례.채용FEES검사,이상각항시간단분별위3례、4례、6례화8례.이MBS평고작위금표준,고체식물、반류식화류식삼류식물MPAS평급균≤4분,이차오흡량소차능해출,칙발제위관.11례환자균발제위관,발제위관평균((x-)±s)시간위(21.7±9.8)d.Kappa일치성검험현시,MBS、FEES량충방법대고체식물화반류식적평고결과문합도교강(Kappa치분별위0.802화0.844),대류식평고결과적문합도일반(Kappa치위0.529).결론 배상연골상후부분절제술후반년내환자탄인공능가회복정상혹기본정상.MBS、FEES량충방법가이객관평고배상연골상후부분절제술후환자탄인공능.FEES인기조작간단,무복사,이비인후의사능자행완성,우기괄용우평고배상연골상후부분절제술후환자탄인공능회복정황.
Objective To investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy.Methods The swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods,the modified barium swallow (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES),combined with modified penetration aspiration scale (MPAS).Furthermore,the feasibility,reliability and accuracy of these two methods were compared.Results Eleven patients were enrolled.MPAS equals score 1 for solid food,semiliquid food,and liquid food was defined as a criteria of normal swallowing function.By MBS evaluation,the numbers of patients with normal swallowing function were two cases at day 16-30 postoperation,two cases at day 31-45 postoperation,five cases at day 46-90 postoperation,and six cases at day 91-180 postoperation,respectively.By FEES evaluation,the above numbers were three cases,four cases,six cases and eight cases,respectively.When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food,semiliquid food,and liquid food,the gastric tube could be removed.According to this standard,the gastric tube was removed in all cases,and the mean time was (21.7 ± 9.8) days.A good correlation was obtained between these two methods when evaluating solid and semiliquid food,and the Kappa values were 0.802 and 0.844,respectively.However,a little agreement was obtained between these two methods when evaluating liquid food,and the Kappa value was 0.529.Conclusions Patients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation.Both the MBS and FEES are valuable procedures for evaluating objectively the swallowing function in patients after supracricoid partial laryngectomy.The FEES is much better than MBS,because FEES is a simple operation performed alone by otolaryngologists with no radiation.