头颈部鳞状细胞癌术后早期吞咽障碍的临床相关因素

doi:10.3969/j.issn.1006-9771.2022.09.010

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (9): 1074-1078.doi: 10.3969/j.issn.1006-9771.2022.09.010

头颈部鳞状细胞癌术后早期吞咽障碍的临床相关因素

程维,薛伶俐,董淋升,李雅冬()

重庆医科大学附属第一医院颌面外科,重庆市 400016

收稿日期:2022-04-18 修回日期:2022-08-02 出版日期:2022-09-25 发布日期:2022-10-08
通讯作者: 李雅冬 E-mail:llxxyydd2006@sina.com
作者简介:程维(1993-),女,汉族,重庆市人,硕士,医师,主要研究方向：头颈肿瘤的治疗。|李雅冬,博士,主任医师,硕士生导师。
基金资助:
重庆市"留创计划"创新项目(cx2019089);重庆市基础研究与前沿探索项目(cstc2018jcyjAX0763)

Factors related to dysphagia early after surgery for head-and-neck squamous cell carcinoma

CHENG Wei,XUE Lingli,DONG Linsheng,LI Yadong()

Department of Oral and Maxillofacial Surgery, the Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Received:2022-04-18 Revised:2022-08-02 Published:2022-09-25 Online:2022-10-08
Contact: LI Yadong E-mail:llxxyydd2006@sina.com
Supported by:
Chongqing Returned Overseas Chinese Entrepreneurship and Innovation Support Plan(cx2019089);Chongqing Basic Research and Frontier Exploration Project(cstc2018jcyjAX0763)

摘要/Abstract

摘要：

目的了解头颈部鳞状细胞癌(HNSCC)患者术后早期吞咽障碍的临床相关因素。
方法对2019年10月至2021年4月在重庆医科大学附属第一医院颌面外科首次接受根治性外科手术治疗HNSCC患者80例,术后2周采用洼田饮水试验、功能性经口摄食量表(FOIs)和M.D.安德森吞咽困难评分量表(MDADI)对患者吞咽功能进行筛查和评价,收集相关随访资料,进行回顾性分析。
结果 HNSCC患者吞咽障碍发生率91.25%。单因素分析显示,肿瘤T分期、部位,同期进行皮瓣修复、颈清扫均会对术后早期吞咽功能产生影响(P < 0.05)。多因素分析显示,肿瘤T分期是吞咽障碍的独立影响因素(B = -5.092, t = -6.770, P < 0.001)。
结论建议常规评估HNSCC患者术后的吞咽功能,特别是恶性程度高的患者,以便及早干预。

关键词: 头颈部鳞状细胞癌, 术后, 吞咽障碍

Abstract:

Objective To explore factors related to dysphagia early after surgery for head-and-neck squamous cell carcinoma (HNSCC).
Methods A total of 80 HNSCC inpatients in Department of Oral and Maxillofacial Surgery, the Frist Affiliated Hospital of Chongqing Medical University, from October, 2019 to April, 2021, were reviewed swallowing function with Kubota water drinking test, Functional Oral Intake Scale (FOIs) and M.D. Anderson Dysphagia Inventory (MDADI), two weeks after radical surgery for the first time; while the related data were collected and analyzed.
Results The incidence of early post-operative dysphagia was 91.25%. The T stages of the tumor, the location of the primary tumor, simultaneous flap repairment and neck dissection were the factors related to dysphagia (P < 0.05), and T stages of the tumor was the independent factor (B = -5.092, t = -6.770, P < 0.001).
Conclusion It's necessary to evaluate the swallowing function of HNSCC patients after surgery, especially for those in worse stages, for early intervention.

Key words: head-and-neck squamous cell carcinoma, post-operation, dysphagia

中图分类号:

R739.8

程维,薛伶俐,董淋升,李雅冬. 头颈部鳞状细胞癌术后早期吞咽障碍的临床相关因素[J]. 《中国康复理论与实践》, 2022, 28(9): 1074-1078.

CHENG Wei,XUE Lingli,DONG Linsheng,LI Yadong. Factors related to dysphagia early after surgery for head-and-neck squamous cell carcinoma[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1074-1078.

图/表 3

表1

表2

表3

参考文献 32

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变量	n	MDADI	t/r/H值	P值
性别			-0.490^a	0.620
男	58	66.64±1.02
女	22	67.64±1.85
年龄	80	66.91±7.97	0.137^b	0.890
肿瘤部位			27.591^c	< 0.001
颊部	12	73.58±6.09
舌部	30	63.67±5.76
口底	16	69.06±8.50
腭部	4	62.75±1.71
牙龈	12	71.50±8.20
口咽部	6	57.66±3.20
肿瘤的T分期			32.560^c	< 0.001
T1	12	77.75±1.89
T2	20	69.10±1.25
T3	36	64.53±0.87
T4	12	59.58±2.21
皮瓣修复			4.720^a	0.001
是	32	62.34±6.43
否	48	69.95±7.46
同期颈淋巴结清扫			2.410^a	0.020
是	50	65.30±7.17
否	30	69.60±8.60

自变量	赋值
肿瘤的位置	颊部 = 1,舌部 = 2,口底 = 3,腭部 = 4,牙龈 = 5,口咽 = 6
肿瘤的T分期	T1 = 1,T2 = 2,T3 = 3,T4 = 4
同期皮瓣转移修复	是 = 1,否 = 0
同期行颈淋巴清扫术	是 = 1,否 = 0

变量	B	SE	β	95%CI	t值	P值
肿瘤的位置	-0.192	0.458	-0.037	-1.104~0.720	-0.420	0.676
肿瘤的T分期	-5.092	0.843	-0.590	-6.770~-3.411	-6.037	< 0.001
T1
T2	-8.605	2.159	-0.473	-12.951~-4.349	-4.006	< 0.001
T3	-13.220	1.971	-0.831	-17.148~-9.296	-6.707	< 0.001
T4	-18.170	2.414	-0.820	-22.975~-13.358	-7.525	< 0.001
同期行颈淋巴清扫术	-1.340	1.526	-0.082	-4.379~1.700	-0.878	0.383
同期皮瓣转移修复	-1.919	1.761	-0.119	-5.427~1.590	-1.089	0.280

头颈部鳞状细胞癌术后早期吞咽障碍的临床相关因素

Factors related to dysphagia early after surgery for head-and-neck squamous cell carcinoma

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