Các yếu tố dự đoán cho việc đặt ống thông dạ dày qua da nội soi (PEG) phòng ngừa và sử dụng ở bệnh nhân ung thư đầu cổ sau điều trị bằng xạ trị điều biến cường độ (IMRT): Sự đồng thuận, sai lệch, và vai trò của Gabapentin

Dysphagia - Tập 31 - Trang 206-213 - 2016
Wuyang Yang1, Todd R. McNutt1, Sara A. Dudley1, Rachit Kumar1, Heather M. Starmer2, Christine G. Gourin2, Joseph A. Moore1, Kimberly Evans1, Mysha Allen1, Nishant Agrawal2,3, Jeremy D. Richmon2,3, Christine H. Chung3, Harry Quon1,2,3
1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
3Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA

Tóm tắt

Việc đặt ống thông dạ dày qua da nội soi phòng ngừa (PEG) ở bệnh nhân ung thư đầu và cổ (HNC) là một vấn đề gây tranh cãi. Chúng tôi đã tìm cách xác định các yếu tố liên quan đến việc đặt PEG phòng ngừa và sử dụng PEG thực tế. Kể từ năm 2010, dữ liệu về việc đặt PEG và sử dụng được ghi lại một cách tiên tiến trong cơ sở dữ liệu của bộ phận từ tháng 1 năm 2010 đến tháng 12 năm 2012. Các bệnh nhân HNC được điều trị bằng xạ trị điều biến cường độ (IMRT) đã được đánh giá hồi cứu từ năm 2010 đến năm 2012. Các biến số có khả năng liên quan đến việc nuốt khó sau xạ trị theo tài liệu trước đó và kinh nghiệm của chúng tôi đã được đánh giá. Chúng tôi đã thực hiện hồi quy logistic đa biến trên các biến số này với việc đặt PEG và sử dụng PEG, lần lượt, để so sánh sự khác biệt trong mối liên hệ giữa hai nhóm. Chúng tôi đã xác định 192 bệnh nhân HNC được điều trị bằng IMRT. Việc đặt PEG phòng ngừa đã xảy ra ở 121 (63,0 %) bệnh nhân, với việc sử dụng PEG ở 97 (80,2 %) bệnh nhân. Việc đặt PEG liên quan đến giới tính nam (p < 0,01), giai đoạn N ≥ N2 (p < 0,05), khó khăn trong việc nuốt trước điều trị (p < 0,01), hóa trị đồng thời (p < 0,01), KPS trước điều trị ≥80 (p = 0,01), và phẫu thuật trước đó (p = 0,02). Hóa trị đồng thời (p = 0,03) có mối quan hệ tích cực với việc sử dụng thức ăn PEG bởi bệnh nhân, trong khi KPS trước điều trị ≥80 (p = 0,03) và việc sử dụng gabapentin phòng ngừa (p < 0,01) có mối liên hệ tiêu cực với việc sử dụng PEG. Phân tích cho thấy có sự không nhất quán giữa việc đặt ống PEG phòng ngừa và sử dụng thực tế. KPS trước điều trị thuận lợi, không có khó nuốt trước điều trị, không có hóa trị đồng thời, và việc sử dụng gabapentin có liên quan đáng kể đến việc giảm sử dụng PEG. Phân tích này có thể giúp tinh chỉnh các chỉ định cho việc đặt ống PEG phòng ngừa.

Từ khóa

#tube PEG #ung thư đầu cổ #xạ trị điều biến cường độ #khó nuốt #gabapentin

Tài liệu tham khảo

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