- 期刊
甲狀腺癌患者術後主觀的吞嚥障礙研究
Patient-reported Swallowing Dysfunction after Treatment in Thyroid Cancer Patients
摘要
背景：甲狀腺癌的發生率在全世界逐年上升，其治療後所產生之吞嚥障礙的後遺症，過在去並沒有被高度重視，在台灣甲狀腺癌的病人，其治療後吞嚥障礙的情況以及相關的影響因子也沒有被詳細探討，本研究之目的在於探討甲狀腺癌的患者治療後主觀吞嚥障礙的情況及相關影響因子。方法：自2017年1月到6月收集44名甲狀腺癌乳突癌接受手術的患者，病人接受主觀吞嚥評估工具（中文版EAT-10問卷）的評估，收集可能影響主觀吞嚥障礙的變項，包括性別、年齡、身高、體重，手術方式、能量器械使用，治療結束至問卷評估時間，疾病、期別、術後放射性碘治療以及喉返神經受損與否。統計分析比較各個變項與EAT-10分數的差異。結果：30名女性，14名男性，年齡平均51歲（標準差11歲），發現年齡、性別、身高體重指數、手術方式，能量器械使用，治療結束至問卷評估時間，術後放射性碘治療與否都與EAT10分數沒有統計差異（p＞0.05）。手術前已有5人喉返神經障礙，術後有兩人喉返神經障礙，而喉返神經障礙的病人（EAT-10分數：6 ± 7.2）比起無喉返神經障礙的患者（1.0 ± 2.3）有較高分數（p-value=0.01）。44名患者有8名（18％）有主觀吞嚥障礙（EAT≧3），年齡、性別、身高體重指數、手術方式，能量器械使用，治療結束至問卷評估時間，術後放射性碘治療都與主觀吞嚥障礙沒有統計差異（p＞0.05）。喉返神經障礙的病人（3/7,43％）比起無喉返神經障礙的患者（5／37,14％）有較高的主觀吞嚥障礙趨勢，但未達統計上的顯著差異（p＝0.06）。結論：甲狀腺乳突癌患者接受治療後主觀吞嚥障礙約有18％。其中43％喉返神經障礙的病人會有主觀吞嚥障礙；而無喉返神經障礙的病人也14％的病人會有主觀吞嚥障礙。
並列摘要
BACKGROUND: The incidence of thyroid cancer has been gradually increasing worldwide. The sequelae of swallowing dysfunction after thyroid cancer treatment have not been well known in the past. The related factors after thyroid cancer treatment in Taiwan have not been elucidated in detail. The purpose of this study was to investigate subjective swallowing dysfunction and related factors after treatment. METHODS: From January to June 2017, 44 patients with thyroid papillary cancer who underwent surgery were enrolled. The patients were evaluated by the patient-oriented swallowing assessment tool, the EAT-10 questionnaire, and variables that may affect subjective swallowing disorders, including sex, age, and surgical method, were collected. Other variables included the use of an energy device during surgery, the timing from the end of treatment to the questionnaire assessment, postoperative radioactive iodine treatment and whether vocal fold function impairment was observed. Statistical analysis compared the differences between each variable and the EAT-10 score. RESULTS: There were 30 females and 14 males, with an average age of 51 years (standard deviation 11 years). Age, sex, body weight, height, surgical method, use of energy devices, time from the end of treatment to the questionnaire evaluation, and postoperative radioactive iodine treatment were not significantly different regarding EAT-10 scores ( p ＞ 0.05). Patients with recurrent laryngeal nerve disorder (6 ± 7.2) had higher EAT-10 scores ( p = 0.01) than patients without recurrent laryngeal nerve disorder (1.0 ± 2.3). Eight (18%) patients had subjective dysphagia (EAT ≥ 3). Additionally, age, sex, body mass index, surgical method, use of energy equipment, time from treatment end to questionnaire evaluation, and postoperative radioactive iodine treatment did not differ in subjective dysphagia ( p ＞ 0.05). Patients with recurrent laryngeal nerve disorder (3/7, 42%) were more likely to have subjective dysphagia ( p = 0.06) than patients without recurrent laryngeal nerve disorder (5/37, 14%). CONCLUSIONS: Approximately 18% of patients with thyroid papillary carcinoma after treatment had a subjective swallowing disorder. Among them, 42% of patients with recurrent laryngeal nerve disorder had subjective dysphagia, whilemost patients without recurrent laryngeal nerve disorder did not have subjective dysphagia.