Analysis of postoperative dysphagia in patients with hypopharyngeal cancer using 320-row ADCT

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K18766
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 56050:Otorhinolaryngology-related
• Research Institution: Aichi Medical University (2021-2022); Nagoya University (2019-2020)
• Principal Investigator: Takashi Maruo 愛知医科大学, 医学部, 講師 (00774118)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: 頭頸部癌 / 術後嚥下障害 / 320列ADCT

Outline of Final Research Achievements

Swallowing function were analyzed using 320-row ADCT in patients who underwent resection and reconstruction of hypopharyngeal cancer.
In patients who underwent resection and reconstruction of oropharynx and partial hypopharynx, the laryngeal elevation was tilted and elevated as if pulled to the unaffected side due to resection of the suprahyoid muscles on the affected side. Axial sectioning showed that rotational movements were also added. These movements guided the swallowed barium to the affected side without aspiration. The pharyngeal contraction of the unaffected mucosa approached the reconstruction flap and the rate of closure differed according to the type of reconstruction flap.In the analysis of the free jejunal reconstruction cases, the pharyngeal jejunal anastomosis was dilated during swallowing, and the swallowing pressure was not transmitted to the anorectal side. This was considered to be the cause of regurgitation into the nasopharynx after swallowing.

Free Research Field

頭頸部癌術後嚥下障害　頭頸部内視鏡手術開発

Academic Significance and Societal Importance of the Research Achievements

切除後の残存組織の動態より、再建皮弁の選択や訓練計画の一助となる結果が得られた。特に咽頭収縮には、ボリュームの多い皮弁の方が有利であることがわかった。また訓練に関しても残存組織を中心に強化するようなものが有効であることが考えられた。手術においても、残存組織の運動が残るような愛護的な操作や切除の工夫が必要であることがわかった。
喉頭を全摘し、遊離空腸で再建した症例では、咽頭縫合部の拡張で嚥下圧が肛門側へ伝わっていないことがわかり、嚥下圧を逃さないように用手的に抑える代償嚥下や訓練で、数例改善をみた。また再建方法の工夫も想起され、今後、想起された新しい訓練法や術式の効果を検討していく必要がある。