Objective: This study was performed to investigate the feasibility of preservation of internal branch of superior laryngeal nerve(ibSLN) during transoral endoscopic surgery for hypopharyngeal squamous cancer(HSCC) and the influence on patient's swallowing function after operation. Methods: From May 2020 to June 2021, the data of 29 HSCC patients who required for transoral endoscopic surgery in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University were prospectively included, and the included patients were divided into two groups randomly by lottery. According to whether ibSLN was actively dissected during operation, they were divided into ibSLN preservation group (n=15) and control group (n=14, without ibSLN preservation). Operation time, intraoperative hemorrhage, intraoperative neck dissection, postoperative radiotherapy, postoperative recurrence within 1 year, retention and swallowing function, the recovery of oral soft diet and the quality of life were compared between two groups. SPSS 25.0 software was used for statistical analysis. Results: The study included 29 eligible patients, including 25 males and 4 females.The age ranged from 42 to 67 (56.07±5.93) years. There were no significant differences(P>0.05) between 2 groups in the following data,including age(t=-0.56), gender(χ2=0.01), TNM stage(T stageχ2=0.29, N stage χ2=0.02), pathological diagnosis(χ2=0.03), preoperative swallowing function(χ2=0.00) and M. D. Anderson Dysphagia Inventory(MDADI) score(global t=0.55, emotional t=0.16, functional t=0.60, physical t=0.64), operation time(t=1.62) and intraoperative hemorrhage(t=-1.46), intraoperative neck dissection(χ2=0.01), postoperative radiotherapy(χ2=0.32), postoperative recurrence within 1 year(P>0.050). The swallowing function was evaluated by water swallowing test after operation. The swallowing function of ibSLN preservation group was better than control group, and the difference between two groups was statistically significant on the 1st (χ2=4.44, P=0.035), 5th (χ2=4.24, P=0.039) and 7th (χ2=4.55, P=0.033) day after operation. On the 14th day after operation, the MDADI scores of patients in the ibSLN preservation group were higher than those in the control group in global (t=2.45, P=0.021), functional (t=2.54, P=0.017) and physical (t=2.24, P=0.034) dimensions, except for emotional dimension (t=1.89, P=0.070). The median time of oral soft diet(U=23.00, P<0.001), normal oral diet(U=21.00, P<0.001) and the nasogastric tube removal time (U=18.50, P<0.001) in ibSLN preservation group was 2 days, 5 days and 6 days respectively, earlier than that in control group, which had statistically significant difference. Conclusion: Our results show that it is feasible to preserve the ibSLN during HSCC transoral endoscopic surgery, which can achieve rapid recovery of postoperative swallowing function.
目的： 探讨下咽鳞状细胞癌（hypopharyngeal squamous cancer，HSCC）经口内镜手术中解剖保护喉上神经内支（internal branch of superior laryngeal nerve，ibSLN）的可行性及对患者吞咽功能的影响。 方法： 前瞻性纳入2020年5月至2021年6月于中南大学湘雅二医院耳鼻咽喉头颈外科接受经口内镜手术的29例HSCC患者资料，并通过抽签将患者随机分为保留ibSLN组（15例）和对照组（14例，不保留ibSLN）。比较2组在手术时间、出血量、术中颈清扫、术后放射性治疗、术后1年内复发、术后吞咽功能、恢复经口进食时间及生活质量上的差异。采用SPSS 25.0软件进行统计学分析。 结果： 研究最终纳入29例符合标准的患者，其中男性25例，女性4例，年龄42~67（56.07±5.93）岁。2组患者在年龄（t=-0.56）、性别（χ2=0.01）、TNM分期（T分期χ2=0.29、N分期χ2=0.02）、病理诊断（χ2=0.03）、术前吞咽功能（χ2=0.00）及安德森吞咽困难量表（M.D. Anderson Dysphagia Inventory，MDADI）评分（总体t=0.55、情感t=0.16、功能t=0.60、生理t=0.64）、手术时间（t=1.62）、术中出血量（t=-1.49）、术中颈清扫（χ2=0.01）、术后放射性治疗（χ2=0.32）、术后1年内复发等方面的差异均无统计学意义（P值均>0.05）。术后进行洼田饮水试验评定吞咽功能，ibSLN保留组在术后第1天（χ2=4.44，P=0.035）、第5天（χ2=4.24，P=0.039）和第7天（χ2=4.55，P=0.033）吞咽功能正常患者比例高于对照组，差异有统计学意义。术后第14天对患者进行MDADI量表评分，除情感维度（t=1.89，P=0.070）外，ibSLN保留组在总体（t=2.45，P=0.021）、功能（t=2.54，P=0.017）、生理（t=2.24，P=0.034）3个维度评分均高于对照组。ibSLN保留组患者术后经口进软食（U=23.00，P<0.001）、正常经口饮食（U=21.00，P<0.001）、拔出胃管（U=18.50，P<0.001）中位时间分别为2 d、5 d、6 d，均早于对照组，差异有统计学意义。 结论： HSCC经口内镜手术中解剖保护ibSLN是可行的，能较好地实现患者术后吞咽功能的快速恢复。.