以螢光透視錄影吞嚥檢查評估鼻咽癌患者因放射線治療所致之吞嚥功能異常

Dysphagia in Individuals with Nasopharyngeal Cancer Following Radiotherapy-Videofluoroscopic Swallowing Examination

林裕晴(Yu-Ching Lin) ； 張允中(Yeun-Chung Chang) ； 王亭貴(Tyng-Guey Wang) ； 陳信水(Hsin-Shui Chen) ； 雷德(Louis Tak Lui)

《慈濟醫學雜誌》 10卷4期 (1998/12) Pp. 293-298

https://doi.org/10.6440/TZUCMJ.199812.0293

摘要

放射線治療是鼻咽癌的主要療法之一，但患者常在接受治療後產生吞嚥功能異常。本研究的目的是利用螢光透視錄影吞嚥檢查評估鼻咽癌患者因放射線治療所致之吞嚥功能障礙。自民國83年1月至7月間43位鼻咽癌患者因接受放射線治療而致吞嚥障礙，被轉至臺大醫院復健部接受臨床評估及螢光透視錄影吞嚥檢查。螢光透視錄影吞嚥檢查是採Logemann改良式鋇鹽攝影。結果顯示63%患者有不正常之舌頭活動度，56%患者有咽鼻逆流的情形，79%患者之鋇鹽滯留於咽部，79%患者有會厭軟骨後傾異常，而有吞嚥反射延遲和吸入現象的患者分別為79%及89%。放射治療後時間較久之患者於螢光透視錄影吞嚥檢查有較嚴重的舌頭活動度受限。照射劑量大小則似乎和吞嚥障礙的嚴重度並無相關。我們認為接受放射線治療的鼻咽癌患者，有高比率會產生吞嚥障礙，螢光透視錄影吞嚥檢查可客觀地發現吞嚥異常的問題所在。

關鍵字

鼻咽癌 ； 放射線治療 ； 吞嚥異常 ； 螢光透視錄影吞嚥檢查

並列摘要

The purpose of this study was to define the impairment of swallowing functions in nasopharyngeal cancer (NPC) patients after radiotherapy. Forty-three NPC patients were referred to our department for evaluation and management of dysphagia from January 1994 through July 1994. Clinical information was obtained by an experienced speech pathologist. Videofluoroscopic swallowing examinations (VSE) were used to evaluate their swallowing functions. The results showed that 63% of the patients had impaired tongue movement, 56% experienced nasopharyngeal regurgitation, 79% had pharyngeal stasis, abnormal epiglottis tilting, and delayed swallowing reflexes, and 89% had aspiration phenomenon. The patients who had received radiotherapy more than 5 years prior to VSE had significantly reduced tongue movement compared with those who received radiotherapy within 5 years. The dosage of radiation was not related to the severity of dysphagia. We found that the NPC patients had a high risk of dysphagia following radiotherapy. VSE may identify the exact causes of their swallowing problems and provide crucial information for prescribing proper rehabilitation programs.

並列關鍵字

Nasopharyngeal cancer ； radiotherapy ； dysphagia ； videofluoroscopic swallowing examination