摘要
目的探讨环状软骨舌骨会厌固定术后吞咽功能评估的方法与效果。方法选择2014年2月至2017年1月就诊的声门型喉癌患者92例,所有患者均给予环状软骨舌骨会厌固定(CHEP)治疗与功能重建,在术后进行改良X射线吞咽造影(MBS)与纤维内镜吞咽(FEES)检查,记录误吸(MPAS)计分,并随访患者的预后情况。结果有1例患者不能拔管,其余91例术后拔气切套管时间为(12.04±5.42)周,术后拔胃管时间为(8.00±2.19)d;术后3个月喉功能良84例,中6例,差2例;术后并发症发生率为6.5%;术后3个月患者的基频与基频微扰都明显低于术前(P<0.05)。随着术后时间的延长,MBS与FEES评估患者的MPAS评分都呈现明显降低的趋势(P<0.05),MBS评估术后15 d为(3.87±0.98)分,术后30 d为(1.64±0.65)分,术后60 d为(1.09±0.33)分;FEES评估术后15 d为(3.27±1.33)分,术后30 d为(1.73±1.11)分,术后60 d为(1.18±0.89)分。以MBS检查结果为金标准,吞咽食物时FEES检查对于正常、误侵、误吸的灵敏度分别为100.0%、76.7%和86.7%,特异度分别为86.7%、97.1%和98.3%。结论应用声门型喉癌环状软骨舌骨会厌固定对喉缺损修复和功能重建能有效保留喉功能,减少术后并发症的发生,改善发音功能,MBS与FEES评价术后喉功能都较准确,对了解术后误吸程度有临床意义。
Objective To investigate the evaluation ways and effects of swallowing function after cricohyoidoepiglottopexy （CHEP）. Methods Selected 92 patients of glottic carcinoma who were admitted into hospital from February 2014 to January 2017, and all the patients were given cricohyoidoepiglottopexy （CHEP） therapy and function reconstruction. Modified barium swallow （MBS）, modified penetration aspiration scale （MPAS） ,and fiberoptic endoscopic evaluation of swallowing （FEES） were applied after the surgery. And the prognosis of patients was followed up. Results There was one patient who was not able to extubate, and the extubation time of tracheaostomy tube and stomach tube were respectively （ 12.04 ± 5.42） week and （8.00 ± 2.19） d among the remaining 9l cases. Three months after operation, the laryngeal function were good in 84 cases, moderate in 6 cases and poor in 2 cases, the incidence of complications was 6.5%. The fundamental frequency and fundamental frequency perturbation three months after operation were significantly lower than thos before operation（ P 〈 0.05 ）. With the extension of postoperative time, the MPAS score of patients with MBS and FEES evaluation were obviously decreased （ P 〈 0.05 ）. The MBS assessment score were respectively （3.87 ±0.98） points, （ 1.64 ±0.65） points, （ 1.09 ±0.33） points at 15 days,30 days and 60 days after operation. The FEES evaluation score were respectively （3.27 ± 1. 33 ） points, （ 1.73 ± 1.11 ） points, （ 1.18 ±0.89 ） points at 15 days,30 days and 60 days after operation. With the MBS assessment as the gold standard, the sensitivity of FEES assessment to normal ,false aspiration and aspiration were 100% ,76.7% and 86.7% , respectively, and the specificity were 86.7% ,97.1% and 98.3% , respectively. Conclusion The cricohyoidoepiglottopexy and laryngeal defect repair in the treatment of glottic carcinoma can effectively preserve the laryngeal function, reduce the incidence of postoperative complications, im
出处
《局解手术学杂志》
2018年第2期119-123,共5页
Journal of Regional Anatomy and Operative Surgery
关键词
声门型喉癌
环状软骨舌骨会厌固定术
功能重建
喉功能
评价方法
glottie cancer
cricohyoidoepiglottopexy
functional reconstruction
laryngeal function
evaluation methods
