目的:TORS是一种替代放化疗治疗口咽恶性肿瘤的微创手术方法。虽然术后早期口咽吞咽困难与TORS有关,这项研究探讨了主观和客观吞咽结果。
方法:对2018年至2023年因口咽恶性肿瘤接受TORS治疗的患者进行回顾性和前瞻性回顾。
方法:单一三级转诊中心。
方法:对142例接受TORS的患者进行术后经鼻饲管。关于肿瘤学的数据,临床,外科,和病理参数,包括VFSS记录,吞咽疼痛,和进料管移除定时,被收集。对POD-1进行临床吞咽检查(CSE),如果不确定,则进行正式的吞咽研究。一旦确认安全吞咽,开始口服饮食,取下了饲管,大多数患者在POD-2上出院。
结果:手术当天的平均年龄为59.3岁,腭扁桃体(N=101)是主要的亚位点。98%的患者(N=139)在术中放置了dobhoff饲管。在POD-1上,对119名患者进行了CSE,26%(37/119)的总口服饮食清除(NOMS≥4)。此外,73名VFSS患者中有30名被清除用于总口服饮食。在POD-2上排放之前,总共有54.9%(78/142)的饲管被移除,平均时间为6.5±6.6天。总的来说,71.1%(101/142)在TORS后一周内达到总口服饮食。
结论:TORS术后早期吞咽对口咽部恶性肿瘤至关重要。VFSS评估术后吞咽安全性,允许大多数患者在TORS后不久恢复全部口服营养。
OBJECTIVE: TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this
study explores both subjective and objective swallowing outcomes.
METHODS: Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023.
METHODS: Single tertiary referral center.
METHODS: Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow
study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2.
RESULTS: At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS.
CONCLUSIONS: Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.