后颅窝肿瘤患儿的喂养与吞咽功能及吞咽困难风险：一项意大利初步队列研究

文献信息

中文摘要

引言： 吞咽困难是后颅窝肿瘤（PFTs）患儿术后常见的并发症，然而尽管儿科神经肿瘤学领域对功能结局的关注日益增加，早期吞咽轨迹的特征仍不够明确。
方法： 在这项于三级转诊中心进行的前瞻性队列研究中，采用儿科吞咽困难筛查优先评估（PS-PED）、美国言语-语言-听力协会国家结局测量系统（ASHA NOMS）吞咽量表和Karaduman咀嚼表现量表（KCPS），在三个标准化时间点评估喂养和吞咽功能：术前、术后一周和术后四周。根据肿瘤组织学（髓母细胞瘤[MB]、毛细胞型星形细胞瘤[PA]、室管膜瘤[EP]）和切除范围（部分切除 vs. 全切除）使用非参数方法进行组间比较。
结果： 共纳入45名儿童。在所有测量指标中，吞咽功能呈现动态的术后轨迹，术后一周显著恶化，术后四周部分恢复；然而，许多儿童在此时间范围内并未恢复到基线状态。肿瘤特征和手术因素显著影响这些轨迹：与PA相比，EP和MB与更高的吞咽困难风险和更差的功能性经口进食相关，部分切除始终与更差的吞咽结局相关。咀嚼表现呈现类似的急性下降模式，随后逐渐改善，但亚组间差异有限。
讨论： 这些发现强调了PFTs术后早期恢复的异质性，支持将系列多维评估整合到常规护理中，并强调需要早期、个体化的康复策略以优化短期功能结局并为未来的预后研究提供信息。

英文摘要

INTRODUCTION: Dysphagia is a frequent postoperative complication in children undergoing surgery for posterior fossa tumors (PFTs), yet early swallowing trajectories remain insufficiently characterized despite the growing focus on functional outcomes in pediatric neuro-oncology.
METHODS: In this prospective cohort study conducted at a tertiary referral center, feeding and swallowing function were assessed at three standardized time points: preoperatively, one week postoperatively, and four weeks postoperatively using the Pediatric Screening Priority Evaluation for Dysphagia (PS-PED), the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) Swallowing Scale, and the Karaduman Chewing Performance Scale (KCPS). Group comparisons were performed according to tumor histology (medulloblastoma [MB], pilocytic astrocytoma [PA], ependymoma [EP]) and extent of resection (partial vs. gross total) using non-parametric methods.
RESULTS: Forty-five children were enrolled. Across all measures, swallowing function followed a dynamic postoperative trajectory, with substantial deterioration at one week and partial recovery at four weeks; however, many children did not return to their baseline status within this timeframe. Tumor characteristics and surgical factors significantly shaped these trajectories: EPs and MBs were associated with higher dysphagia risk and poorer functional oral intake compared with PAs, and partial resections were consistently linked to worse swallowing outcomes. Chewing performance exhibited a similar pattern of acute decline, followed by gradual improvement, with limited differentiation across subgroups.
DISCUSSION: These findings underscore the heterogeneity of early postoperative recovery in PFTs, support the integration of serial multidimensional assessments in routine care, and highlight the need for early, individualized rehabilitation strategies to optimize short-term functional outcomes and inform future prognostic research.