口咽鳞状细胞癌多模式治疗及桡前臂游离皮瓣重建后患者报告的吞咽困难：与 FEES 结果、心理困扰及口干症的关联
Patient-Reported Dysphagia After Multimodal Therapy and Radial Forearm Free-Flap Reconstruction for OPSCC: Associations With FEES Findings, Psychological Distress, and Xerostomia.
文献信息
| PMID | 42908754 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Inga Marte Charlott Seuthe |
| 作者单位 | Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Hagen University of Witten/Herdecke Hagen Germany. |
| 期刊 | Laryngoscope investigative otolaryngology |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 本研究探讨在口咽鳞状细胞癌（OPSCC）患者接受以手术为基础的多模式治疗并游离皮瓣重建后，纤维光学内镜吞咽评估（FEES）衍生参数是否反映患者报告的吞咽困难及吞咽相关生活质量。此外，评估心理困扰和口干症在此背景下的作用。
方法： 这项多中心、横断面探索性研究纳入50例患者。FEES参数包括穿透-误吸量表（PAS）和残留评分。患者报告结局采用悉尼吞咽问卷（SSQ）和MD Anderson吞咽困难量表（MDADI）评估，心理困扰采用医院焦虑抑郁量表（HADS）评估，口干症采用口干症量表（XI）评估。关联性采用Spearman相关分析（Benjamini-Hochberg校正）及探索性秩转换多元线性回归检验。
结果： 校正后，FEES参数与SSQ或MDADI总分无显著双变量关联。HADS和XI与SSQ及MDADI呈中度至强双变量关联。在探索性多变量分析中，HADS（β=0.372，p=0.012）和PAS最大值（β=0.318，p=0.006）与SSQ独立相关，而XI不相关（β=0.268，p=0.065）。HADS（β=-0.339，p=0.008）、XI（β=-0.433，p<0.001）和PAS最大值（β=-0.301，p=0.003）与MDADI独立相关。
结论： FEES衍生参数仅部分反映患者报告的吞咽障碍。这些发现支持对治疗后吞咽困难的多维理解，并建议在该特定患者群体的随访护理中常规整合心理社会和症状导向的评估。
证据等级： 4。
试验注册： 德国临床试验注册中心（DRKS）注册号：DRKS00038870。
英文摘要
OBJECTIVE: This study investigated whether fiberoptic endoscopic evaluation of swallowing (FEES)-derived parameters reflect patient-reported dysphagia and swallowing-related quality of life in patients with oropharyngeal squamous cell carcinoma (OPSCC) after surgery-based multimodal therapy with free-flap reconstruction. In addition, it assessed the roles of psychological distress and xerostomia in this context.
METHODS: This multicenter, cross-sectional exploratory study included 50 patients. FEES parameters comprised Penetration-Aspiration Scale (PAS) and residue scores. Patient-reported outcomes were assessed using the Sydney Swallow Questionnaire (SSQ) and MD Anderson Dysphagia Inventory (MDADI), psychological distress using the Hospital Anxiety and Depression Scale (HADS), and xerostomia using the Xerostomia Inventory (XI). Associations were examined using Spearman correlations with Benjamini-Hochberg correction and exploratory rank-transformed multiple linear regression.
RESULTS: FEES parameters showed no significant bivariate associations with SSQ or MDADI total scores after correction. HADS and XI showed moderate to strong bivariate associations with SSQ and MDADI. In exploratory multivariable analyses, HADS (β = 0.372, p = 0.012) and PAS max (β = 0.318, p = 0.006) were independently associated with SSQ, whereas XI was not (β = 0.268, p = 0.065). HADS (β = -0.339, p = 0.008), XI (β = -0.433, p < 0.001), and PAS max (β = -0.301, p = 0.003) were independently associated with MDADI.
CONCLUSION: The FEES-derived parameters only partially reflected patient-reported swallowing impairment. These findings support a multidimensional understanding of post-therapeutic dysphagia and suggest routine integration of psychosocial and symptom-oriented assessments into follow-up care in this specific patient population.
LEVEL OF EVIDENCE: 4.
TRIAL REGISTRATION: German Clinical Trials Register (DRKS) Registration Number: DRKS00038870.