喉切除术后吞咽障碍的发生机制及康复研究进展

吞咽障碍作为喉切除术后的常见并发症,严重影响患者的生活质量。喉切除术包括全喉切除术和喉部分切除术。全喉切除患者的吞咽障碍多是由于食团下咽阻力增加、食管蠕动障碍、新造咽的狭窄而造成。喉部分切除术后因吞咽相关解剖结构损伤或缺失,导致声门下压力降低、气管保护机制下降、声门开闭受损,呼吸与吞咽动作协调紊乱,患者常出现呛咳、误吸等症状。吞咽障碍的评估方法分为主观评估和客观评估。主观评估包括临床床旁检查和吞咽障碍量表评估。客观评估常采用吞咽造影检查、纤维内镜吞咽功能检查和高分辨率压力测量。早期吞咽康复训练、心理干预以及家属参与康复护理及出院后的延续护理等均可促进喉切除术后患者吞咽功能康复。

Advance in Mechanism and Rehabilitation of Dysphagia after Laryngectomy (review)

As a common complication after laryngectomy, dysphagia seriously impaired the quality of life of patients. Laryngectomy included total laryngectomy and partial laryngectomy. Swallowing resistance increasing, esophageal dysmotility and stenosis of new pharynx all resulted in dysphagia after total laryngectomy. The damage or absence of swallowing anatomy after partial laryngectomy led to sub glottal pressure reducing, and trachea protection mechanism and open/close of the glottis impairing, disturbing breathing and swallowing coordination, and result in choking, aspiration, and so on. Dysphagia was assessed subjectively and objectively. Subjective methods included beside examination and swallowing disorder scales. Objective methods included Videofluoroscopic Swallow Study, Fiberoptic Endoscopic Examination of Swallowing and High-resolution Manometry. Early swallowing rehabilitation training, psychological intervention and family members participating in rehabilitation nursing and continuing nursing after discharge could promote the recovery of swallowing function of patients after laryngectomy.