CAJ | 학술논문

背景与目的：鼻咽癌放疗后吞咽功能障碍评价方法多为主观的问卷调查，缺乏有效的客观检测方法，本研究旨在探索鼻咽癌放疗后吞咽功能障碍的评价方法，了解鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。方法：连续选取2013年10月—2013年12月门诊复查的128例鼻咽癌放疗后患者，其中调强放疗(intensity modulated radiation therapy，IMRT)组患者89例，常规放疗(conventional radiotherapy， CRT)组患者39例。采用食道钡剂造影方法，评价吞咽功能障碍情况。每位患者吞食3种不同浓度的钡剂，并在X线透视下动态观察不同浓度钡剂在通过口腔、咽部和食道时是否存在以下问题：①在口腔受阻无法下咽；②分流至声门或气管；③潴留在梨状窝和舌会厌隙；④舌骨、会厌活动受限；⑤通过咽部不畅，时间延长；⑥通过食道入口处速度减慢。结果：在128例患者中，食道钡剂造影检测出吞咽功能障碍总发生率为60.2%，调强组和常规组分别为52.8%和76.9%(P=0.018)；放疗后1年内、1~2年和2年后发病率分别为63.1%、33.3%和69.0%(P=0.019)。结论：鼻咽癌放疗后吞咽功能障碍较多见，采用IMRT的患者其发生率较低。食道钡剂造影可以客观的评价鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。
배경여목적：비인암방료후탄인공능장애평개방법다위주관적문권조사，결핍유효적객관검측방법，본연구지재탐색비인암방료후탄인공능장애적평개방법，료해비인암방료후탄인공능장애적발병정황급기엄중정도。방법：련속선취2013년10월—2013년12월문진복사적128례비인암방료후환자，기중조강방료(intensity modulated radiation therapy，IMRT)조환자89례，상규방료(conventional radiotherapy， CRT)조환자39례。채용식도패제조영방법，평개탄인공능장애정황。매위환자탄식3충불동농도적패제，병재X선투시하동태관찰불동농도패제재통과구강、인부화식도시시부존재이하문제：①재구강수조무법하인；②분류지성문혹기관；③저류재리상와화설회염극；④설골、회염활동수한；⑤통과인부불창，시간연장；⑥통과식도입구처속도감만。결과：재128례환자중，식도패제조영검측출탄인공능장애총발생솔위60.2%，조강조화상규조분별위52.8%화76.9%(P=0.018)；방료후1년내、1~2년화2년후발병솔분별위63.1%、33.3%화69.0%(P=0.019)。결론：비인암방료후탄인공능장애교다견，채용IMRT적환자기발생솔교저。식도패제조영가이객관적평개비인암방료후탄인공능장애적발병정황급기엄중정도。
Background and purpose:Currently, subjective questionaire is the most frequently used methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, while lacking of effective objective examinations. This study aimed to explore effective methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, and gain knowledge of the incidence and severity of swallowing dysfunctions. Methods: From Oct. 2013 to Dec. 2013, 128 consecutive outpatients with previously treated nasopharyngeal carcinoma received esophageal barium lfuoroscopy examination at there regularly follow-ups to evaluate swallowing function. Among these patients, 89 were primary treated with intensity modulated radiation therapy (IMRT) and 39 with conventional radiotherapy (CRT). In this study, each patient received esophageal barium lfuoroscopy examination for 3 times with thin, thick and pasty barium and were dynamically observed using X-ray fluoroscopy from front and lateral direction. Swallowing dysfunctions were defined as follows:①The bolus could not be swallowed and blocked in the mouth;②The dilute barium diverted to the glottis or trachea;③Residual barium delayed in the pyriform sinus and vallecula;④The movement of the hyoid bone or epiglottis were restricted;⑤Bolus prolong through the pharynx;⑥Barium slowed down when went though the esophageal entrance. Results:Of the 128 patients, incidence of dysphagia was 60.2%for the entire cohort, 52.8%for IMRT group and 76.9%for CRT group. Incidence of dysphagia for IMRT group was signiifcantly lower than CRT group (P=0.018). Dysphagia incidence within 1 year, 1 to 2 years and more than 2 years after RT were 63.1%, 33.3%and 69.0%, respectively (P=0.019). Conclusion:There was a high incidence of swallowing dysfunction for the nasopharyngeal carcinoma patients treated with radiotherapy and dysphagia incidence decreased when treated with IMRT. Esophageal barium lfuoroscopy examination is objective method to evaluate the incidence and severity of the swallowing dysfunction.