鼻咽癌放疗后远期吞咽功能的纤维喉镜评估

Evaluation of the effect of fiberoptic endoscopic evaluation of swallowing on long-term survivor with nasopharyngeal cancer

目的探讨纤维喉镜吞咽检查在鼻咽癌放疗后长期存活患者吞咽功能评估的应用价值。方法通过对107例鼻咽癌放疗后长期存活的患者进行纤维喉镜检查,应用咽期残留量表及食物渗透及误吸量表评估咽期残留、渗透及误吸情况。结果107例患者均完成纤维喉镜吞咽评估,鼻咽癌放疗后随诊时间为5~14年,平均(8.78±2.91)年,声门内收反射减弱或消失22例(20.56%),鼻咽反流及关闭不全23例(21.49%),声带活动减弱或声带麻痹50例(46.72%)。53.06%患者存在对于粥样食物严重梨状窝残留,而45.79%患者对水以及29.90%患者对粥样食物存在误吸。结论通过对鼻咽癌放疗后长期存活患者进行纤维喉镜吞咽评估,较多患者存在严重吞咽障碍,其中粥样食物残留及水样食物误吸较常见。

Objective To examine the effect of applying fiberoptic endoscopic evaluation of swallowing(FEES)on long-term survivors of nasopharyngeal cancer.Methods Fiberoptic endoscopic evaluation of swallowing was conducted on 107 patients with nasopharyngeal carcinoma who were previously treated by radiotherapy.The Yale pharyngeal residue severity rating and Rosenbek penetration-aspiration scale were used to evaluate pharyngeal residue,penetration,and aspiration.Results A total of 107 patients were included in survey,with a median follow-up time of 8.78±2.91 years(range:5-14 y).Late complications noted in the participants were impairment of the glottic adduction reflex(n=22,20.56%),nasopharyngeal reflux(n=23,21.49%),and vocal cord(n=50,46.72%).The detection rate of pharyngeal residue on FEES with porridge was 53.06%,while that of aspiration on FEES with liquid and porridge was 45.79%and 29.90%,respectively.Conclusion The use of FEES in long-term survivors with nasopharyngeal cancer led to serious radiotherapy-induced dysphagia,particularly in pharyngeal residue with porridge and aspiration with liquid and porridge.