透視螢光吞嚥檢查與吞嚥內視鏡檢查在吞嚥障礙評估的角色

The Roles of Videofluoroscopic Swallowing Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in the Assessment of Dysphagia

邱翊翔(Yi-Hsiang Chiu) ； 曾文萱(Wen-Hsuan Tseng) ； 王亭貴(Tyng-Guey Wang)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 73-80

https://doi.org/10.6315/TJPMR.202012_48(2).0001

摘要

吞嚥障礙是許多中樞神經性疾患及口咽腔腫瘤常見的後遺症。一旦發生吞嚥障礙，對於患者生理及心理都會造成影響，進而影響生活品質。如何確實評估吞嚥功能異常並給予適時的治療成為一項重要的課題。透視螢光吞嚥檢查（videofluoroscopic swallowing study）與吞嚥內視鏡檢查（fiberoptic endoscopic evaluation of swallowing）是吞嚥障礙患者常接受的儀器檢查。大部分的學者將透視螢光吞嚥檢查視為吞嚥檢查的黃金準則，但也有學者認為吞嚥內視鏡檢查可提供許多額外的資訊且具足夠的正確性，是優於透視螢光吞嚥檢查的方法，這種討論一直存在。本文藉由完整的文獻回顧作出以下結論：若是要評估局部的咽喉構造，則建議先進行吞嚥內視鏡檢查；若是要評估吞嚥生理變化，則建議先進行透視螢光吞嚥檢查。透視螢光吞嚥檢查與吞嚥內視鏡檢查在吞嚥後咽部殘留物及滲入-吸入量表級數的評估上具有高度一致性，且在治療上不會因為選擇這二項檢查的不同而影響肺炎的發生率。因此，透視螢光吞嚥檢查與吞嚥內視鏡檢查皆可當作吞嚥障礙的客觀評估工具。

關鍵字

透視螢光吞嚥檢查（videofluoroscopic swallowing study） ； 吞嚥內視鏡檢查（fiberoptic endoscopic evaluation of swallowing） ； 吞嚥障礙（dysphagia） ； 滲入－吸入量表（penetration-aspiration scale）

並列摘要

Dysphagia is a prevailing complication of various central nervous diseases and oral pharyngeal cancer. Once dysphagia occurred, it may affect a patient's physical and psychological condition and thus their quality of daily activities. Therefore, early detection and the application of appropriate treatments for patients with dysphagia is essential. Videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) are two common instrument modalities used to evaluate swallowing function. VFSS has been acknowledged as the gold standard for the diagnosis of dysphagia by most scholars. Nevertheless, there is debate that FEES is superior to VFSS as it provides additional information with sufficient accuracy. Therefore, we conducted a comprehensive literature review to compare the differences between the two instrument modalities. Our results showed that FEES is more suitable for the evaluation of the local structures of the pharynx, whereas VFSS is more appropriate for the evaluation of swallowing physiology. Both VFSS and FEES in assessing post-swallowing pharyngeal residue and penetration-aspiration scale had high consistency. Besides, the pneumonia incidence showed no difference in terms of the treatment strategy based on the results of either FEES or VFSS. Hence, both VFSS and FEES can be used as an objective assessment tool for dysphagia.

並列關鍵字

videofluoroscopic swallowing study ； fiberoptic endoscopic evaluation of swallowing ； dysphagia ； penetration-aspiration scale

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