40例舌鳞癌根治同期修复重建术患者吞咽功能变化的纵向研究

Changes of swallowing function in 40 patients with tongue squamous cell carcinoma after simultaneous reconstruction: a longitudinal study

目的:调查40例舌鳞癌根治同期修复重建患者手术前、后的吞咽功能变化,寻找患者最佳吞咽康复时机。方法:使用吞咽功能专用评估方法洼田饮水试验(WST)及经口摄食功能评估量表(FOIS),对40例舌鳞癌根治同期修复重建手术患者术前(S0)、术后7~10天(S1)、术后3个月(S2)、术后6个月(S3)、术后12个月(S4)的吞咽功能进行评估。采用Graphpad prism 5.0软件包对资料进行单因素方差分析、秩和检验。结果:患者术后吞咽和进食功能普遍较差,尤其是S1期显著下降,S2期和S3期逐渐升高,S4期除个别患者外基本恢复至术前状态。WST结果显示,S3期、S4期患者吞咽功能与S0期吞咽功能差异无统计学意义(P>0.05);FOIS结果显示,S4期患者进食能力与S0期进食能力差异无统计学意义(P>0.05),患者摄食功能恢复较吞咽功能晚6个月。T4患者在S4期吞咽和进食能力恢复较T2、T3患者差,差异有统计学意义(P<0.05)。无舌根缺失患者在S4期的进食能力恢复较有舌根缺失者好,差异有统计学意义(P<0.05);术后无放化疗患者在S4期的进食能力恢复较放化疗患者好,差异有统计学意义(P<0.05)。结论:部分患者术前即存在轻度吞咽障碍,术后3~6个月是患者吞咽功能康复的最佳时机,需加强T4患者、术后有舌根缺失及放、化疗患者的健康宣教及吞咽康复训练。

PURPOSE: To investigate the changes of swallowing function in 40 patients with tongue squamous cell carcinoma undergoing radical resection and simultaneous repair and reconstruction 1 year after operation, to find the best swallowing rehabilitation opportunity for patients, and to provide targeted swallowing function guidance for patients.METHODS: The swallowing function of 40 cases of tongue squamous cell carcinoma undergoing simultaneous reconstructive surgery before(S0), 7 days to 10 days(S1), 3 months(S2), 6 months(S3), and 12 months(S4) after surgery were tested by the special evaluation method of swallowing function such as water swallowing test(WST) and the functional oral intake scale(FOIS). The data were analyzed using GraphPad Prism 5.0 software packages. RESULTS:Postoperative deglutition and feeding function were poor, especially in stage S1, which decreased significantly, and in stage S2 and S3, which accumulated gradually. Except for some patients, stage S4 patients returned to the preoperative state.WST results showed that there wasn’t significant difference in swallowing function between stage S3, S4 patients and stage S0 patients(P>0.05). FOIS results showed that there was no significant difference in feeding function between S4 stage patients and S0 stage patients(P >0.05). The recovery of the feeding function was 6 months later than that of the swallowing function. The recovery of swallowing and feeding ability of patients with T4 tumor was worse than that of patients with T2 and T3 in stage S4, and the difference was statistically significant(P<0.05). The recovery of feeding ability in stage S4 patients was better in patients without tongue root deficiency than those with tongue root deficiency, and the difference was statistically significant(P<0.05). Postoperatively, patients without radiotherapy or chemotherapy had a better recovery of feeding function in S4 than those with radiotherapy or chemotherapy, and the difference was statistically significant(P <0.05). CONCLUSIONS: Some patients had mild dysphagia before operation, and 3 to 6 months after operation is the best time for patients to recover their swallowing function. It is important to strengthen health education and swallowing rehabilitation training of T4 patients and patients with loss of tongue, radiotherapy, and chemotherapy.