VFSS联合FEES在卒中吞咽障碍患者中的诊断价值

Application of video fluoroscopic swallowing study combined with fiberoptic endoscopic examination of swallowing in the diagnosis of dysphagia after stroke

目的探讨视频透视吞咽造影(VFSS)联合纤维鼻咽喉镜吞咽功能检查(FEES)在老年患者卒中后吞咽障碍诊断中的价值。方法选取徐州医科大学附属医院卒中伴有吞咽障碍的住院患者34例,进行VFSS及FEES检查。结果 VFSS显示口腔期吞咽障碍25例,咽期吞咽障碍30例(咽缩肌无力28例、舌根后缩无力15例、会厌翻转运动差28例、滞留28例、渗漏23例、隐性误吸8例、显性误吸10例),食管期吞咽障碍17例(环咽肌开放不全10例、完全不开放5例、反流2例)。FEES检查发现:咽缩肌无力25例,会厌翻转运动差24例,滞留27例,声门闭合不良21例,渗漏23例,误吸15例,其中还发现声带新生物及喉癌等4例。结论 VFSS联合FEES在咽期吞咽障碍诊断中检出率基本一致,既能相互佐证,又能相互补充。VFSS评估包括从口腔期到咽期到食道期,而FEES仅能观察咽期,但是FEES更直观,在卒中合并咽喉部器质性病变中有着不可替代的价值。

Objective To evaluate the application of video fluoroscopic swallowing study(VFSS)combined with fiberoptic endoscopic examination of swallowing(FEES)in the diagnosis of patients with dysphagia after stroke.Methods A total of 34 stroke patients with dysphagia who were admitted in the Affiliated Hospital of Xuzhou Medical University were enrolled.All patients underwent both VFSS and FEES.Results VFSS results showed that 25 cases of oral dysphagia,30 cases of pharyngeal dysphagia(including 28 cases of weakness in the constrictor muscle of pharynx,15 cases of weakness for tongue base retraction,28 cases of poor motor ability in epiglottic turnover,28 cases of detention,23 cases of leakage,8 cases of recessive aspiration,and 10 cases of dominant aspiration),and 17 cases of esophageal dysphagia(including 10 cases of incomplete opening of the cricopharyngeal muscle,5 cases of complete closure of the cricopharyngeal muscle,and 2 cases of esophageal reflux).FEES results showed that there were 25 cases of weakness in the constrictor muscle of pharynx,24 cases of poor motor ability in epiglottic turnover,27 cases of detention,21 cases of malocclusion of the glottis,23 cases of leakage,and15 cases of aspiration,in addition to 4 cases of vocal cord neoplasm and laryngeal cancer.Conclusions In the diagnosis of pharyngeal dysphagia,the detection rate of VFSS combined with FEES is basically the same,which is complementary.VFSS can evaluate from oral stage to esophageal stage,while FEES can observe at the pharynx in a more direct manner.