鼻咽癌放疗后吞咽困难的评估

【目的】评估鼻咽癌放疗后的吞咽状况。【方法】对106例鼻咽癌患者在治疗前和治疗后1年内定期评估患者吞咽情况，评估方法包括患者自觉的吞咽困难评分（patient-reported dysphagia ，PRD），观察者评定的评分（observer-reported dysphagia ，ORD）以及客观检查---电视透视（videofluoroscopy ，VF）检查评分。根据放疗结束后3个月到放疗结束后12个月记录到的最大的O RD评分把病人分为A、B、C、D、E五个组，对各组PRD得分以及V F得分进行对比分析。【结果】A组的吞咽困难程度除PRD评分总体困扰维度外明显低于其他各组，其他四组间的吞咽困难程度差异无显著性。PRD评分吞咽困难阳性率高于ORD评分以及VF评分阳性率。【结论】吞咽困难作为一个主观症状，尤其是轻度的吞咽困难，可能被临床医师所低估。鼻咽癌放疗结束后的吞咽困难可能成为耳鼻咽喉-头颈外科医师面临的重要任务之一。

Evaluation of Dysphagia after Radiotherapy for Nasopharyngeal Cancer

Objective To evaluate the swallowing status of nasopharyngeal cancer after radiotherapy .[Methods]The swallowing status of 106 patients with nasopharyngeal cancer 1 year before and after treatment was evaluated regularly .The evaluation methods included patient-reported dysphagia（PRD） ,observer-repor-ted dysphagia（ORD） and objective examination videofluoroscopy （VF） score .According to maximal ORD scores from 3 months to 12 months after radiotherapy ,all patients were divided into 5 groups .PRD and VF scores were compared among 5 groups .[Results] PRD scores except overall curse dimension of dysphagia degrees in group 1 were obviously lower than those in other groups ,but there was no significant difference in dysphagia degree among group 2 ,3 ,4 and 5 .The positive rate of dysphagia according to PRD score was higher than the positive rate of dysphagia according to ORD and VF scores .[Conclusion]Dysphagia as a objective symptom ,especially mild dysphagia may be underestimated by clinicians .Dysphagia of nasopharyngeal cancer after radiotherapy is likely to become one of the important tasks for our otolaryngology-head-neck surgeons .