不同修复方式重建舌缺损术后吞咽功能的比较

Research of swallowing function after tongue reconstruction by different methods

目的:通过电视X线透视吞咽功能检测(videofluoroscopic swallowing study,VFSS),评价舌体与舌根缺损对吞咽功能的影响和吞咽功能恢复的修复重建方式。方法:采用VFSS对健康志愿者、舌体缺损与舌根缺损修复重建患者各10例的吞咽过程进行研究,并对吞咽困难的表现(呛咳或误吸)和发生率的变化、吞咽黏稠食物能力的改变、残余量的改变、咽腔清除时间的改变等数据采用SAS14.0软件包进行Kruskal-Wallis检验,明确3组吞咽功能改变是否存在显著差异。结果:舌体缺损不会增加患者术后发生呛咳和误吸的风险,而舌根缺损会明显增大术后发生呛咳和误吸的风险(分别为0%、0%和60%);舌缺损部位的不同,可直接影响患者术后对黏稠食物的吞咽能力,健康志愿者组>舌体组>舌根组[(9.33±0.50)mL,(6.25±2.12)mL,(0.70±1.16)mL];吞咽效率比较,健康志愿者组>舌体组>舌根组。结论:舌体组吞咽功能的恢复优于舌根组,修复重建方式的选择主要取决于缺损的部位和大小。

PURPOSE： To explore the reconstructive methods by examining and evaluating the rehabilitation of swallowing function with videofluoroscopic swallowing study（VFSS）.METHODS： The patients were divided into 3 group,including control group（healthy volunteers,n=10）,mobile tongue group after reconstruction（n=10）,and tongue base group after reconstruction（n=10）.The dynamic swallowing process was recorded by VFSS in all subjects.The data in 3 groups included the performance of dysphagia（irritating cough or aspiration） and the incidence rate of irritating cough and aspiration,the change of the ability to swallow viscous food,the change of residual amount（oral cavity and pharyngeal space）,the change of pharyngeal clearance time.The results were analyzed with Kruskal-Wallis test by SASS14.0 software package to compare whether there was significant difference in the swallowing function among 3 groups.RESULTS： The risk of postoperative irritating cough and aspiration was not increased in the patients with defect in mobile tongue,but significantly increased in patients with defect in tongue base（0%,0%,60%）.The patients ability to swallow viscous food in control group（9.33±0.50 mL） was better than that of tongue mobile group（6.25±2.12 mL） and tongue base group（0.70±1.16 mL）.Swallowing efficiency in control group was better than that of mobile tongue group and tongue base group,and the latter was the worst.CONCLUSIONS： The decrease in swallowing efficiency in tongue base group is greater than that of mobile tongue group,the choice of reconstructive method depends on site and volume of the tongue defect.Supported by Research Fund of Science and Technology Commission of Shanghai Municipality（08DZ2271100） and Key Project of Biomedicine of Science and Technology Commission of Shanghai Municipality（10DZ1951300）.