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随着头颈部肿瘤发病率的升高以及发病渐趋年轻化,以放疗和手术为基础的综合治疗有了快速的发展,但是吞咽困难仍是头颈部肿瘤患者放疗后的常见并发症,原发肿瘤位置(如喉或下咽)、侵犯范围、手术切除、放疗靶区及治疗剂量等多种因素共同导致吞咽困难的形成[1]。头颈部肿瘤放疗后的吞咽困难会导致患者出现营养不良、误吸、吸入性肺炎、焦虑等问题,降低患者的生活质量,甚至缩短其生存期[2]。对于有较好预后且能长期生存(如人乳头状瘤病毒相关头颈部肿瘤等)的患者,必须面对吞咽困难这一问题[3]。笔者针对吞咽系统的解剖及生理过程、头颈部肿瘤患者放疗后吞咽困难的形成原因、放疗对吞咽困难发生发展过程的影响、吞咽困难的评估以及吞咽功能训练等方面进行综述。
头颈部肿瘤放疗后吞咽困难防治的研究现状
Research status of prevention and treatment of dysphagia after radiotherapy for head and neck tumors
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摘要: 吞咽困难是头颈部肿瘤放疗后常见的不良反应,在接受放化疗的头颈部肿瘤患者中,超过76%的患者会出现吞咽困难,轻者降低生活质量,重者可能危及生命。吞咽困难的形成与肿瘤分期、治疗方法和康复计划等相关,其预防和治疗是保障头颈部肿瘤患者生活质量的关键,但是目前临床防治措施明显不完善。笔者从吞咽系统的解剖及生理过程、放疗后头颈部肿瘤患者吞咽困难的形成原因、放疗对头颈部肿瘤患者吞咽困难发生发展过程的影响、吞咽困难的评估以及吞咽功能训练等方面进行综述,以期进一步为头颈部肿瘤患者放疗后出现吞咽困难的防治提供思路。Abstract: Dysphagia is the common adverse reaction after the radiotherapy for head and neck tumors. More than 76% of patients with head and neck cancer who received chemoradiotherapy had difficulty swallowing. The life quality of patients with mild dysphagia will be affected, while patients with severe symptoms may suffer from life danger. The existence of dysphagia is related to the tumor status, treatment methods, rehabilitation means and so on. Its prevention and treatment are the key to ensure the quality of life of patients with head and neck cancer. However, the current clinical prevention and treatment methods are obviously insufficient. This paper researches the anatomical and physiological process of swallowing system and the causes of the formation of dysphagia in head and neck tumors, and makes a review on the influence of radiotherapy on its developmental process, the evaluation of dysphagia and the prevention measures such as the training of swallowing functions in order to provide more thoughts on further preventing the appearance of dysphagia.
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Key words:
- Head and neck neoplasms /
- Radiotherapy dosage /
- Deglutition disorders /
- Quality of life
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