食管癌患者术前的舌根肌肉质量与食管切除术后的吞咽功能有关。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2024-06-26 DOI:10.1002/ags3.12839

Sanshiro Kawata, Yoshihiro Hiramatsu, Junko Honke, Tomohiro Murakami, Eisuke Booka, Tomohiro Matsumoto, Yoshifumi Morita, Hirotoshi Kikuchi, Katsuya Yamauchi, Hiroya Takeuchi

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引用次数: 0

摘要

目的：食管切除术后经常会出现吞咽困难。舌根肌参与吞咽动作，但其在食管切除术患者中的意义仍不明确。我们研究了术前舌骨后肌质量与食管切除术后吞咽功能的关系：我们对 114 例因食管恶性肿瘤接受食管切除术和胃导管重建术的患者进行了回顾性分析。我们使用计算机断层扫描评估了术前舌骨后肌矢状横截面积（平方厘米）。每个性别的中位值被视为临界值。在术后7-10天进行的视频荧光吞咽检查中，我们使用吞咽困难量表（PAS）对吞咽困难的严重程度进行了评估：男性的横截面积明显大于女性（3.2 ± 0.7 vs. 2.4 ± 0.5，P 2；女性：2.3 cm2）。这些数值被用来定义高横截面积组和低横截面积组。横截面积与握力（相关系数 (CC) = 0.530）和骨骼肌指数（CC = 0.541）呈正相关。转甲状腺素水平（22.4 ± 6.8 vs. 25.4 ± 5.5，P = 0.03）和横截面积（2.6 ± 0.7 vs. 3.2 ± 0.8，P = 0.03）。在多变量分析中，低横截面积和喉返神经麻痹都是吞咽研究中发生误吸的独立风险因素（几率比分别为 3.6，p = 0.03 和 6.6，p = 0.02）：结论：使用颈部计算机断层扫描评估术前舌骨后肌肉质量可预测食管切除术后的吞咽困难。

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Preoperative geniohyoid muscle mass in esophageal cancer patients is associated with swallowing function after esophagectomy

Aim

Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post-esophagectomy swallowing function.

Methods

We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross-sectional areas (cm²) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration–Aspiration Scale (PAS) during video-fluoroscopic swallowing studies performed 7–10 days postoperatively.

Results

The cross-sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p < 0.01: median in males: 3.2 cm², and in females: 2.3 cm²). These values were used to define high and low cross-sectional area groups. The cross-sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, p = 0.03) and cross-sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, p < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, p = 0.03). In the multivariate analysis, low cross-sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, p = 0.03 and odds ratio = 6.6, p = 0.02, respectively).

Conclusion

Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy.

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