食道钡剂造影在评价鼻咽癌放疗后吞咽功能障碍中的运用

doi:10.3969/j.issn.1007-3969.2015.05.009

中国癌症杂志 ›› 2015, Vol. 25 ›› Issue (5): 371-376.doi: 10.3969/j.issn.1007-3969.2015.05.009

食道钡剂造影在评价鼻咽癌放疗后吞咽功能障碍中的运用

林冯杰¹，徐鹭英¹，陈惠琴²，李华圣³，邱素芳¹，林少俊¹，胡彩容¹，陆军¹

1. 福建医科大学教学医院，福建省肿瘤医院放疗科，福建福州 350014 ；
2. 福建医科大学省立临床医学院，福建福州 350014 ；
3. 福建医科大学教学医院，福建省肿瘤医院放诊科，福建福州 350014

出版日期:2015-05-30 发布日期:2015-08-11
通信作者: 徐鹭英　E-mail:xly6208@sina.com
基金资助:
福建省医学创新课题(2011-CX-15)。

Dysphagia after radiotherapy: esophageal barium fluoroscopy examination of swallowing in nasopharyngeal carcinoma patients

LIN Fengjie¹, XU Luying¹, CHEN Huiqin², LI Huasheng³, QIU Sufang¹, LIN Shaojun¹, HU Cairong¹, LU Jun¹

1.Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou Fujian 350014, China; 2.Provincial Clinical College of Fujian Medical University, Fuzhou Fujian 350014, China; 3.Department of Radiology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou Fujian 350014, China

Published:2015-05-30 Online:2015-08-11
Contact: XU Luying E-mail: xly6208@sina.com

摘要/Abstract

摘要： 　 背景与目的：鼻咽癌放疗后吞咽功能障碍评价方法多为主观的问卷调查，缺乏有效的客观检测方法，本研究旨在探索鼻咽癌放疗后吞咽功能障碍的评价方法，了解鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。方法：连续选取2013年10月—2013年12月门诊复查的128例鼻咽癌放疗后患者，其中调强放疗(intensity modulated radiation therapy，IMRT)组患者89例，常规放疗(conventional radiotherapy，CRT)组患者39例。采用食道钡剂造影方法，评价吞咽功能障碍情况。每位患者吞食3种不同浓度的钡剂，并在X线透视下动态观察不同浓度钡剂在通过口腔、咽部和食道时是否存在以下问题：①在口腔受阻无法下咽；②分流至声门或气管；③潴留在梨状窝和舌会厌隙；④舌骨、会厌活动受限；⑤通过咽部不畅，时间延长；⑥通过食道入口处速度减慢。结果：在128例患者中，食道钡剂造影检测出吞咽功能障碍总发生率为60.2%，调强组和常规组分别为52.8%和76.9%(P=0.018)；放疗后1年内、1~2年和2年后发病率分别为63.1%、33.3%和69.0%(P=0.019)。结论：鼻咽癌放疗后吞咽功能障碍较多见，采用IMRT的患者其发生率较低。食道钡剂造影可以客观的评价鼻咽癌放疗后吞咽功能障碍的发病情况及其严重程度。

关键词: 鼻咽癌, 放射治疗, 吞咽功能障碍, 食道钡剂造影

Abstract: Background and purpose: Currently, subjective questionaire is the most frequently used methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, while lacking of effective objective examinations. This study aimed to explore effective methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, and gain knowledge of the incidence and severity of swallowing dysfunctions. Methods: From Oct. 2013 to Dec. 2013, 128 consecutive outpatients with previously treated nasopharyngeal carcinoma received esophageal barium fluoroscopy examination at there regularly follow-ups to evaluate swallowing function. Among these patients, 89 were primary treated with intensity modulated radiation therapy (IMRT) and 39 with conventional radiotherapy (CRT). In this study, each patient received esophageal barium fluoroscopy examination for 3 times with thin, thick and pasty barium and were dynamically observed using X-ray fluoroscopy from front and lateral direction. Swallowing dysfunctions were defined as follows: ①The bolus could not be swallowed and blocked in the mouth; ②The dilute barium diverted to the glottis or trachea; ③Residual barium delayed in the pyriform sinus and vallecula; ④The movement of the hyoid bone or epiglottis were restricted; ⑤Bolus prolong through the pharynx; ⑥Barium slowed down when went though the esophageal entrance. Results: Of the 128 patients, incidence of dysphagia was 60.2% for the entire cohort, 52.8% for IMRT group and 76.9% for CRT group. Incidence of dysphagia for IMRT group was significantly lower than CRT group (P=0.018). Dysphagia incidence within 1 year, 1 to 2 years and more than 2 years after RT were 63.1%, 33.3% and 69.0%, respectively (P=0.019). Conclusion: There was a high incidence of swallowing dysfunction for the nasopharyngeal carcinoma patients treated with radiotherapy and dysphagia incidence decreased when treated with IMRT. Esophageal barium fluoroscopy examination is objective method to evaluate the incidence and severity of the swallowing dysfunction.

Key words: Nasopharyngeal carcinoma, Radiotherapy, Dysphagia, Esophageal barium fluoroscopy

林冯杰,徐鹭英,陈惠琴,等. 食道钡剂造影在评价鼻咽癌放疗后吞咽功能障碍中的运用[J]. 中国癌症杂志, 2015, 25(5): 371-376.

LIN Fengjie, XU Luying, CHEN Huiqin, et al. Dysphagia after radiotherapy: esophageal barium fluoroscopy examination of swallowing in nasopharyngeal carcinoma patients[J]. China Oncology, 2015, 25(5): 371-376.

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食道钡剂造影在评价鼻咽癌放疗后吞咽功能障碍中的运用

Dysphagia after radiotherapy: esophageal barium fluoroscopy examination of swallowing in nasopharyngeal carcinoma patients

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