不同术式喉癌患者术后吞咽功能、认知功能的比较及其危险因素分析

Comparison of postoperative swallowing function and cognitive function in patients with different surgical methods of laryngeal cancer and analysis of their risk factors

目的 分析不同术式喉癌患者术后吞咽功能、认知功能的比较及其危险因素。方法 回顾性选取2020年4月至2023年4月新疆医科大学第一附属医院收治的80例喉癌患者进行研究,根据手术方法不同将患者分为A组(n=26)、B组(n=27)、C组(n=27)。A组行水平半喉切除术,B组行环状软骨-舌骨-会厌固定术(CHEP),C组行垂直半喉切除术。对比三组患者的术后吞咽功能、认知功能,并建立多因素Logistic模型,分析影响术后吞咽功能、认知功能的独立危险因素。结果 C组术后吞咽功能0级率为70.37%,明显高于A(38.46%)、B组(37.04%),差异有统计学意义(P<0.05)。C组术后MOCA、MMSE评分分别为(26.14±2.25)、(27.16±2.14)分,均明显高于A[(24.12±2.34)、(25.14±2.24)分]、B组[(24.45±2.45)、(25.36±2.18)分],差异均有统计学意义(P<0.05)。80例患者的术后吞咽功能障碍发生率为51.25%,认知功能障碍发生率为60.00%。与吞咽功能正常组比较,障碍组年龄≥60岁、TNMⅢ期、颈部淋巴结清扫、气管切开术、水平半喉切除术、CHEP术患者占比较高;与认知功能正常组比较,障碍组年龄≥60岁、初中及以下、水平半喉切除术、CHEP术患者占比较高(P<0.05)。单因素和多因素Logistic分析结果显示,年龄、TNM分期、颈部淋巴结清扫、气管切开术、水平半喉切除术、CHEP术均是导致喉癌患者术后吞咽功能障碍的独立危险因素;年龄、文化程度、水平半喉切除术、CHEP术均是导致喉癌患者术后认知功能障碍的独立危险因素(P<0.05)。结论 垂直半喉切除术手术对喉癌吞咽和认知功能影响较小,水平半喉切除术、CHEP和年龄、文化程度、临床分期等因素均有可能导致喉癌患者引发术后吞咽功能、认知功能障碍。

Objective To analyze the comparison of swallowing function and cognitive function in patients with laryngeal cancer after different surgical methods and their risk factors.Methods Eighty patients with laryngeal cancer admitted to The First Affiliated Hospital of Xinjiang Medical University from April 2020 to April 2023 were selected for the study.According to different surgical methods,the patients were divided into group A(n=26),group B(n=27),and group C(n=27).Group A underwent horizontal hemilaryngectomy,group B underwent cricoid cartilage-hyoid-epiglottis fixation(CHEP),and group C underwent vertical hemilaryngectomy.The postoperative swallowing function and cognitive function of the three groups were compared,and a multivariate Logistic model was established to analyze the independent risk factors affecting postoperative swallowing function and cognitive function.Results The grade 0 rate of postoperative swallowing function in group C was 70.37%,which was significantly higher than that in groups A(38.46%) and B(37.04%),the difference was statistically significant(P<0.05).Postoperative MOCA and MMSE scores in group C were(26.14±2.25),(27.16±2.14) points,which were significantly higher than those in groups A[(24.12±2.34),(25.14±2.24) points] and B[(24.45±2.45),(25.36±2.18) points],the differences were statistically significant(P<0.05).The incidence of postoperative swallowing dysfunction was 51.25%,and the incidence of cognitive dysfunction was 60.00%.Compared with the normal swallowing function group,more patients in the disabled group were ≥60 years old,TNM stage III,cervical lymph node dissection,tracheotomy,horizontal hemilaryngectomy,and CHEP.Compared with the normal cognitive function group,the proportion of patients aged 60 years or older,junior middle school or below,horizontal hemilaryngectomy and CHEP in the disabled group was higher(P<0.05).Univariate and multivariate Logistic analysis showed that age,TNM stage,cervical lymph node dissection,tracheotomy,horizontal hemilaryngectomy and CHEP were independent risk factors for postoperative swallowing dysfunction in laryngeal cancer patients.Age,education level,horizontal hemilaryngectomy and CHEP were independent risk factors for postoperative cognitive dysfunction in laryngeal cancer patients(P<0.05).Conclusion Vertical hemilaryngectomy has little effect on swallowing and cognitive function of laryngeal cancer.Horizontal hemilaryngectomy,CHEP,age,education level,clinical stage and other factors may lead to postoperative swallowing function and cognitive dysfunction in patients with laryngeal cancer.