岛叶胶质瘤术后隐性误吸与吞咽安全损害：一项基于FEES的前瞻性研究

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中文摘要

背景： 尽管岛叶在喉咽感觉运动整合、吞咽调节和气道保护反应中具有重要作用，但岛叶胶质瘤术后的吞咽安全障碍仍未被充分描述。
目的： 描述岛叶胶质瘤切除术后基于FEES的吞咽安全损害特征。
方法： 这项前瞻性单中心观察性研究连续纳入48例接受岛叶胶质瘤切除的患者。所有患者均在术前及术后第3天和第7天接受FEES检查，术后存在异常的患者还在4周、3个月和6个月时额外接受检查。采用渗透-误吸量表（PAS）评估隐性误吸，采用耶鲁咽部残留严重程度评定量表（YPRSRS）评估咽部残留，采用Murray分泌量表评估分泌物管理。
结果： 术后FEES异常在术后第3天最为明显，包括渗透、误吸、隐性误吸、咽部残留和分泌物管理受损。在探索性亚组分析中，吞咽安全障碍在伴有运动缺陷、失语、优势半球肿瘤、内侧或多脑叶延伸以及经皮质/联合入路的患者中似乎更常见。8例患者（16.7%）发生呼吸系统并发症，并与隐性误吸和分泌物管理受损相关。
结论： 隐性误吸和吞咽安全损害是岛叶胶质瘤术后具有临床意义且未被充分认识的后遗症。这些障碍在术后早期最为明显，通常在随访期间消退，但在部分高危患者中可能持续存在。研究结果支持考虑进行早期、结构化的基于FEES的术后评估，以发现临床上隐匿的吞咽安全异常；由于该观察性设计无法确定常规FEES能否改善临床结局，仍需开展基于结局的前瞻性研究。

英文摘要

BACKGROUND: Postoperative swallowing safety disturbances after insular glioma surgery remain insufficiently characterized, despite the insula's important role in laryngopharyngeal sensorimotor integration, swallowing modulation, and airway-protective responses.
OBJECTIVE: To characterize FEES-based swallowing safety impairment after insular glioma resection.
METHODS: This prospective single-center observational study included 48 consecutive patients who underwent resection of insular gliomas. FEES was performed preoperatively and on postoperative days 3 and 7 in all patients, and additionally at 4 weeks, 3 months, and 6 months in patients with postoperative abnormalities. Silent aspiration was assessed using the Penetration-Aspiration Scale (PAS), pharyngeal residue using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), and secretion management using the Murray Secretion Scale.
RESULTS: Postoperative FEES abnormalities were most pronounced on postoperative day 3 and included penetration, aspiration, silent aspiration, pharyngeal residue, and impaired secretion management. In exploratory subgroup analyses, swallowing safety disturbances appeared more frequent in patients with motor deficits, aphasia, dominant-hemisphere tumors, medial or multilobar extension, and transcortical/combined approaches. Respiratory complications occurred in 8 patients (16.7%) and were associated with silent aspiration and impaired secretion management.
CONCLUSIONS: Silent aspiration and swallowing safety impairment are clinically relevant and underrecognized postoperative abnormalities after insular glioma surgery. These disturbances are most pronounced in the early postoperative period, usually regress during follow-up, but may persist in selected high-risk patients. The findings support consideration of early, structured FEES-based postoperative assessment to detect clinically occult swallowing safety abnormalities; because this observational design cannot establish that routine FEES improves clinical outcomes, prospective outcome-based studies are warranted.