口腔癌患者术后吞咽障碍危险因素的系统评价

doi:10.7518/hxkq.2022.03.013

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (3): 328-334.doi: 10.7518/hxkq.2022.03.013

口腔癌患者术后吞咽障碍危险因素的系统评价

卢倩¹^,²(), 郭柳媚², 毕小琴²()

^1.四川大学华西护理学院，成都 610041
^2.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041

收稿日期:2021-08-19 修回日期:2022-01-26 出版日期:2022-06-01 发布日期:2022-06-01
通讯作者: 毕小琴 E-mail:sculuqian@163.com;hxbxq@163.com
作者简介:卢倩，护师，硕士，E-mail：sculuqian@163.com
基金资助:
四川省科技计划项目(2017KZ0022)

Systematic review of risk factors of postoperative dysphagia in patients with oral cancer

Lu Qian¹^,²(), Guo Liumei², Bi Xiaoqin²()

^1.West China School of Nursing, Sichuan University, Chengdu 610041, China
^2.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2021-08-19 Revised:2022-01-26 Online:2022-06-01 Published:2022-06-01
Contact: Bi Xiaoqin E-mail:sculuqian@163.com;hxbxq@163.com
Supported by:
Science and Technology Planning Project of Sichuan Province(2017KZ0022);Correspondence: Bi Xiao-qin, E-mail: hxbxq@163.com

摘要/Abstract

摘要： 目的

通过系统评价的方法探究口腔癌患者术后吞咽障碍的危险因素。

方法

检索中国知网、万方数据库、维普中文期刊数据库、中国生物医学文献服务系统、中国临床试验注册中心、PubMed、Cochrane library、Embase、Web of Science、Clinical Trials数据库，采用主题词结合自由词的检索方式，从建库至2021年6月，搜集口腔癌患者术后吞咽障碍危险因素的队列研究并进行质量评价，提取有效数据并运用RevMan 5.3软件进行分析。

结果

共纳入10篇文献，累计共有患者1 241例，其中暴露组473例，非暴露组768例。经合并效应量发现如下危险因素具有统计学意义，年龄（>60岁）、肿瘤生长部位（口咽、口底）、肿瘤TNM分期（T3、T4）、肿瘤临床Ⅳ期、肿瘤切除范围波及舌骨上肌或舌大部切除（>50%）、行颈淋巴清扫术、气管切开术、修复重建术、术后联合放射性治疗。

结论

现有证据提示，口腔癌患者术后吞咽障碍的危险因素包括：年龄>60岁、肿瘤位于口咽、口底、原发肿瘤为T3或T4、TNM分类Ⅳ期、肿瘤切除范围波及舌骨上肌或舌大部切除>50%、配合颈淋巴清扫术、气管切开术、修复重建术及术后联合放射性治疗。鉴于纳入文献的偏倚较少，敏感分析结论稳定且未受发表偏倚影响，该结论具有一定临床参考价值。

关键词: 口腔癌, 吞咽障碍, 危险因素, 系统评价

Abstract: Objective

This study aims to identify risk factors of postoperative dysphagia in patients with oral cancer by systematic review.

Methods

Cohort studies in Chinese or English on risk factors of postoperative dysphagia in patients with oral cancer were searched from CNKI, Wanfang database, VIP Chinese Journal Database, China Biomedical Literature Service System, Chinese Clinical Trial Registry, PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials from the beginning to June 30, 2021. Subject words combined with free words were used to retrieve related articles. The included studies were evaluated, and the effective data were processed with Revman 5.3.

Results

Ten studies were selected, and they included 1 241 patients consisting of 473 patients in the exposed group and 768 patients in the control group. After the meta-analysis, the risk factors with statistical significance were as follows: age>60 years, tumor located in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy.

Conclusion

Age>60 years, tumor in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy were significant risk factors of postoperative dysphagia in patients with oral cancer.

Key words: oral cancer, dysphagia, risk factors, systematic review

中图分类号:

R 782

卢倩, 郭柳媚, 毕小琴. 口腔癌患者术后吞咽障碍危险因素的系统评价[J]. 华西口腔医学杂志, 2022, 40(3): 328-334.

Lu Qian, Guo Liumei, Bi Xiaoqin. Systematic review of risk factors of postoperative dysphagia in patients with oral cancer[J]. West China Journal of Stomatology, 2022, 40(3): 328-334.

图/表 6

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第一作者及发表年份	国家	例数	评估时间	评估方法	结局指标	NOS得分情况
第一作者及发表年份	国家	例数	评估时间	评估方法	结局指标	选择	可比性	暴露	总分
Hasegawa T，2021^[16]	日本	64	术后1个月	吞咽能力评估量表	①③④	3	3	2	8
Huang ZS，2016^[17]	中国	112	术后3个月	吞咽造影检查	①⑤⑥	3	3	2	8
Klingelh?ffer C，2019^[18]	德国	400	术后第七天	纤维光学内窥镜检查	③④⑦⑧?	3	3	2	8
Miyamoto S，2012^[19]	日本	222	术后进食时	是否依赖胃肠营养管	①②⑥⑨⑩	2	2	2	6
Yamauchi T，2012^[20]	日本	75	出院时	是否依赖胃肠营养管	③⑥⑦⑧	2	2	2	6
Worley ML，2018^[21]	美国	66	术后6个月	功能性经口摄食量表	①③	4	2	2	8
Pezdirec M，2019^[22]	斯洛文尼亚	109	术后随访期间	头颈癌治疗后吞咽障碍问卷	②⑥??	3	2	1	6
Schache AG，2009^[23]	英国	31	术后4个月	功能性经口摄食量表	?	3	2	2	7
Fujimoto Y，2007^[24]	日本	62	术后6个月	口服摄入量及进食方式	①②⑧⑨	3	2	2	7
Smith JE，2008^[25]	美国	100	术后90 d内	改良钡剂试验	①??	3	1	2	6

危险因素	纳入研究数	异质性检验结果		效应模型	Meta分析结果
危险因素	纳入研究数	Q检验P值	I²	效应模型	OR（95%CI）	P值
年龄（>60岁）	2^[19,24]	0.84	0%	固定	2.65（1.38，5.09）	0.003
肿瘤生长部位（口咽、口底）	2^[22-23]	0.63	0%	固定	2.40（1.04，5.55）	0.04
肿瘤TNM分期（T3、T4）	4^{[16,18,20-21]}	0.71	0%	固定	4.64（2.93，7.34）	<0.000 01
肿瘤临床Ⅳ期	4^{[17,19-20,22]}	0.55	0%	固定	2.53（1.61，3.96）	<0.000 1
舌骨上肌切除或舌切除>50%	6^{[16-17,19,21,24-25]}	0.05	55%	随机	3.08（1.73，5.50）	0.000 1
行颈淋巴清扫术	2^[16,18]	0.57	0%	固定	2.76（1.55，4.93）	0.000 6
行气管切开术	2^[18,20]	0.45	0%	固定	2.55（1.46，4.43）	0.000 9
行修复重建术	3^[18,20,24]	0.62	0%	固定	6.69（3.15，14.21）	<0.000 01
术后联合放射性治疗	2^[19,24]	0.34	0%	固定	8.51（3.75，19.32）	<0.000 01

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口腔癌患者术后吞咽障碍危险因素的系统评价

Systematic review of risk factors of postoperative dysphagia in patients with oral cancer

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