目的 评价颈部食管造口术对鼻咽癌放疗后重度吞咽困难患者营养及生活质量的改善作用.方法 对53例行颈部食管造口术鼻咽癌放疗后重度吞咽困难患者进行回顾性分析,观察患者造口术前、术后1个月、6个月、1年及2年的营养指标结果,包括白细胞、淋巴细胞、血红蛋白、总蛋白、白蛋白及转铁蛋白变化及体重、体质量指数的改变.记录患者术前、术后并发肺炎、反流性食管炎情况.同时采用SF-36生活质量量表调查患者食管造口术前术后生活质量的变化.结果 53例鼻咽癌放疗后重度吞咽困难患者行颈部食管造口术后体重增加,营养状况明显改善,肠内营养1个月、6个月、1年及2年后血红蛋白、总蛋白、白蛋白及转铁蛋白及体重、体质量指数均有不同程度的改善,差异均有统计学意义(P＜0.05).肺部感染率由颈部食管造口术前的60.38％(32/53),术后降低至15.22％ (7/46),差异有统计学意义(X2=21.04,P＜0.01);反流性食管炎由颈部食管造口术前的26.42％(14/53),术后降低至6.52％(3/46),差异有统计学意义(X2=5.00,P＜0.01).造口术后1个月、6个月、1年及2年的患者的生理健康和心理健康均较术前有明显改善(P＜0.05),生理功能、社会功能明显高于术前(P＜0.05).结论 鼻咽癌放疗后重度吞咽困难患者行颈部食管造口术后营养状况明显改善,体质量指数增加,血红蛋白、总蛋白、白蛋白及转铁蛋白明显改善.同时颈部食管造口术可减少反流性食管炎及肺部感染,患者耐受性好,生活质量提高.%Objective To evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects.Methods A retrospective study was performed on 53 nasopharyngeal carcinoma (NPC) patients with dysphagia, who received cervical esophagostomy.The nutritional status of these patients was measured at five given time before and after operation.The occurrence of pneumonia and reflux esophagitis before and after operation was recorded, and the quality of life based on SF-36 quality of life (QOL) scale was studied.Results After operation, the nutritional status of these patients improved substantially, including the weight, levels of hemoglobin, total protein, albumin and transferring(P ＜ 0.05).The pneumonia-infection decreased from 60.38％ (32/53) before operation to 15.22％ (7/46) after operation (x2 =21.04, P ＜ 0.01).The incidences of reflux esophagitis decreased from 26.42％ (14/53) without operation to 6.52％ (3/46) after operation (x2 =5.00, P ＜ 0.01).Meanwhile, the status of physical health, mental health as well as physical function and social function of these patients were improved significantly at 1 month, 6 months, 1 year and 2 years after operation (P ＜ 0.05).Conclusion Cervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.
展开▼
