喉部分切除术后患者吞咽障碍评估的回顾性研究

A retrospective study on the assessment of dysphagia after partial laryngectomy

目的 回顾性研究喉部分切除术后患者远期的吞咽功能,探讨洼田饮水试验在该术后吞咽障碍评估中的有效性、可靠性,并分析不同手术方式对吞咽功能的影响有无差异.方法 回顾性分析2012年9月至2015年8月于行喉部分切除术治疗的83例喉癌患者的临床资料.分别进行吞咽问卷调查、洼田饮水试验及吞咽X线造影检查（videofluoroscopic swallowing study,VFSS）.分析问卷结果,根据手术方式行两种分组方法（有无会厌,保留一侧或双侧杓状软骨）,用洼田饮水试验结果分析以上两种分组对吞咽功能的影响,并以VFSS的结果为＂金标准＂,统计分析与洼田饮水试验结果的一致性、可靠性.采用SPSS23.0统计软件包进行数据处理.结果 83例喉部分切除患者,吞咽问卷调查显示非正常饮食者占32.53%,存在痛苦吞咽感受者占43.37%.洼田饮水试验：吞咽障碍发生率为40.96%;保留会厌和切除会厌组中,正常、中度、重度吞咽障碍3组差异具有统计学意义（χ^2=18.160,χ^2=7.229,χ^2=12.344,P值均〈0.05）;保留一侧和双侧杓状软骨组中,正常、中度吞咽障碍两组差异有统计学意义（χ^2=4.790,χ^2=9.110,P值均〈0.05）.31例患者中,VFSS与洼田饮水试验的吞咽功能结果具有一定的一致性和可靠性（Kappa=0.551,r=0.810）.结论 会厌和杓状软骨的保留,对喉部分切除患者术后远期吞咽功能的保留具有重要意义;洼田饮水试验与VFSS结果具有一定的一致性和可靠性,可以作为喉部分切除术后患者远期吞咽障碍的初步筛查工具.

Objective To retrospectively investigate the long-term swallowing function of patients with laryngeal carcinoma , who underwent partial laryngectomy , discuss the effectiveness and reliability of Kubota drinking test in the assessment of patients with dysphagia , who underwent partial laryngectomy , and analyze the influence of different ways of operation on swallowing function .Methods Clinical data were retrospectively analyzed on 83 patients with laryngeal carcinoma , who underwent partial laryngectomy between September 2012 and August 2015. Questionnaire survey , Kubota drinking test and video fluoroscopic swallowing study （ VFSS ） were conducted for patients during a scheduled interview .Patients were grouped by two ways： the one was whether epiglottis was retained , and the other was whether either arytenoids or both were reserved .The influence of different surgical techniques on swallowing function was analyzed according to the results of Kubota drinking test .The agreement and reliability of Kubota drinking test were statistically analyzed with respect to VFSS treated as the gold standard .SPSS23.0 software was used to analyze the data .Results Questionnaire results revealed that among 83 patients underwent partial laryngectomy 32.53% suffered from eating disorder , and 43.37% experienced painful swallowing .The incidence of dysphagia was 40.96% according to the results of Kubota drinking test .There was statistical difference between the group with epiglottis remained and that having epiglottis removed in terms of the absence of dysphagia and severity .The statistical values of normal , moderate and severe dysphagia were in the order of 18.160, 7.229, 12.344（P〈0.05）.Also, statistical difference existed between the groups with either and both arytenoids reserved in terms of the absence of dysphagia as well as that of intermediate severity, and their statistical values were 4.790 and 9.110（P〈0.05）.A certain degree of agreement and＆nbsp;reliability was present between the results of Kubota drinking test and VFSS （Kappa=0.551,r=0.810）. Conclusions It was of considerable significance to reserve epiglottis and arytenoids for the retention of swallowing function for patients post partial laryngectomy . There are certain degree of agreement and reliability between the results of Kubota drinking test and VFSS .The test, therefore, could be used as a tool for screening patients suffering from dysphagia post partial laryngectomy .