物理抗菌材料用于口腔癌术创安全陛的初步观察

目的:观察洁悠神物理抗菌材料用于口腔癌术后预防感染时患者的不良反应情况.方法:从手木当日开始,在口腔、口咽部、鼻咽部以及颈部术创创面(缘)喷洒洁悠神物理抗茵材料,同时行血液学检测.结果:所有患者均未出现明显的痛、痒、过敏等症状,其中有11例患者初次使用时自觉气味欠佳,但仍能够接受并配合治疗.与对照组相比,治疗组患者用药后白细胞,粒细胞,淋巴细胞,血红蛋白,血小板,谷草转氨酶、谷丙转氨酶、白蛋白、球蛋白,尿素氮、肌酐等检测指标均无显著性差异.结论:洁悠神物理抗菌材料作为辅助用药用于口腔癌术后预防感染尚未见明显不良反应.     

物理抗菌喷雾敷料在口腔癌术创预防感染的研究

目的:研究口腔癌术创全身应用抗菌药物的同时,局部应用物理抗菌方法的临床治疗效果。方法:60例口腔癌患者,随机分为治疗组30例和对照组30例。治疗组,从手术当日开始,在口腔、口咽、鼻咽部以及颈部术创喷涂洁悠神物理抗菌喷雾敷料,剂量为0.1mL/次,每日3次,直到术创愈合。对照组,常规口腔护理、换药。观察两组术创外观、愈合等级和愈合时间,血常规、肝肾功能等血液学检测。结果:两组术创愈合等级无显著差异(P>0.05),术创愈合时间治疗组较对照组缩短(P<0.05)。60例均未出现不良反应,用药后血液学检测无显著差异(P>0.05)。结论:口腔癌术后创面局部使用物理抗菌雾敷料在预防感染的安全性和有效性综合指标方面有一定的优势。     

洁悠神物理抗菌喷雾敷料对口腔癌瘤术后菌群的影响

目的:在口腔癌瘤术后创口局部应用物理抗菌喷雾敷料,了解其对患者口腔菌群的影响,为口腔癌瘤术后感染的预防提供参考。方法:64例口腔癌瘤患者,随机分为治疗组32例和对照组32例。对照组:从手术当日开始,术创采用常规的换药和口腔护理方法。治疗组:从手术当日开始,在术创喷涂洁悠神长效抗菌材料,剂量为0.1mL/次,每日3次,直到术创愈合。观察两组术创外观,进行创面细菌培养。结果:术创均顺利愈合,64例均未出现不良反应,实验组链球菌属、葡萄球菌属、奈瑟菌属检出减少(P<0.05)。结论:口腔癌瘤术创局部使用物理抗菌雾敷料对预防术后感染具有一定的作用。     

口腔癌术后的气道管理

目的探讨口腔癌术后患者气道管理措施。方法对38例口腔癌术后的患者进行正确的吸痰、吸氧、气道湿化、气囊处理、局部感染预防等治疗和护理。结果38例患者无出现呼吸道感染、窒息、呛咳、声嘶等并发症。结论对口腔癌术后患者进行精心、正确的气道管理，可降低术后并发症，促进患者术后康复。     

下颌骨内侧牙龈处理改良法对口底瘘预防效果的观察

目的：探讨口腔癌术中预防口底瘘下颌骨内侧牙龈处理手术方法的改进。方法：回顾性分析181例行原发灶－（颌）－颈联合根治术的口腔癌病例,所有患者均采用薄的往复锯离断下颌骨。分析离断及重建过程中牙龈、黏膜微创处理方式,并观察术后口底瘘的发生率。结果：181例病例中,皮瓣存活180例;伤口Ⅰ期愈合179例,口底感染1例,口底瘘1例。结论：在需处理下颌骨的口腔癌根治术中,通过对下颌骨内侧牙龈处理方式的改进,可减少牙龈组织的创伤,降低操作难度,完整封闭口底并有效预防术后口底瘘的发生。     

口腔癌患者术后生存质量评价及影响因素分析

目的：评价口腔癌患者术后的生存质量（quality of life,QOL）,并探讨影响无瘤生存者术后QOL的可能因素。方法：采用SF-36及UW-QOL测量55例口腔癌患者术前和术后12个月的QOL,采用SPSS12.0软件包对数据进行统计学分析。结果：①复发患者术后的QOL显著低于无瘤生存者。②与术前相比,术后12个月时,无瘤生存者仍存在较严重的治疗相关的特异性问题和较差的社会功能状况。③文化程度、婚姻状况、共病、缺损范围及放疗影响无瘤生存者术后QOL,初、高级文化程度、配偶健在、不伴有共病、缺损最大径〈6cm及术后未放疗的患者,术后QOL较高。④不同的颈清扫术式对无瘤生存者手术前后QOL总分的差值没有影响,但副神经保留组术后的肩功能明显优于副神经切除组。结论：保留副神经可改善颈清扫患者的肩功能;降低复发率、加强慢性病的预防及控制、改进放疗手段、增加社会支持及必要的康复指导和治疗可提高口腔癌患者术后的QOL。     

口腔癌患者的口腔健康保健

口腔癌及其治疗会影响患者的口腔健康，使其易罹患龋齿、口腔机会感染、放射性口炎等疾病。因此，口腔癌患者应该注重口腔健康，采取相应的措施防治相关疾病。本文就口腔癌患者预防和治疗龋齿、口腔机会感染和放射性口炎的研究进展作一综述。     

体温保护对口腔癌患者术后加速康复的影响

目的:探讨围术期体温保护对口腔癌患者术后加速康复的影响。方法:选择口腔癌根治术加同期游离皮瓣修复术患者98例为研究对象,分为保温组和对照组,每组各49例。保温组给予电阻式加温垫和温输液进行体温保护。记录2组患者各时间点核心体温;记录手术室温度,麻醉时间,麻醉用药,术中出血量、输血量、输液量、冲洗液量、尿量,手术时间,复苏时间,术后寒战发生率,术后感染率,非计划二次手术发生率及住院时间。结果:与麻醉前比较,2组患者麻醉后2、4、6 h,转入麻醉后监测治疗室(postanesthesia care unit,PACU)和转出PACU时的核心温度明显降低(P<0.05);保温组麻醉后2、4、6 h,转入PACU和转出PACU时的核心温度明显高于对照组(P<0.05)。与对照组比较,保温组术中出血量、输血量小(P<0.05),术后寒战发生率低(P<0.05),复苏时间短(P<0.05),术后总感染发生率低(P<0.05),住院时间明显缩短(P<0.05)。2组手术室温度,麻醉时间,麻醉用药,手术时间,术中输液量、冲洗液量、尿量及非计划二次手术发生率差异无统计学意义。结论:体温保护能够有效预防口腔癌患者围术期低体温的发生,降低术后感染率,缩短住院时间,从而促进患者加速康复。     

老年口腔癌患者手术前后血糖的比较

目的：比较老年口腔癌患者手术前后血糖的变化.方法：对57例70岁以上行口腔癌根治术的患者手术前后空腹血糖进行比较,并与同期其他年龄段行口腔癌根治术患者手术前后空腹血糖进行对比,行统计学分析.结果：所有口腔癌根治术患者术后血糖均较术前升高,而老年口腔癌患者术后血糖升高,较其他年龄段患者血糖升高差异有显著性.结论：胰腺功能和肾功能的减退,是老年口腔癌患者术后血糖升高的主要原因;术后严密的血糖监测和合理,适量的应用胰岛素,是避免老年口腔癌患者术后血糖升高的关键.     

口腔癌患者手术前后外周血免疫指标的检测及其临床意义

目的 探讨口腔癌患者手术前后免疫功能状态变化及其临床应酬意义。方法：采集口腔癌患者手术前后的外周静脉血，流式细胞仪检测CD3 总T淋巴细胞、CD4 辅助性T细胞、CD8 杀伤，抑制性T细胞、CD4 ，CD8 比值、CDl9 总B淋巴细胞、CDl6 /CD56 NK细胞。酶联免疫吸附法(ELISA)检测外周血肿瘤坏死因子-α(TNF-α)和可溶性白细胞介素-2受体(sIL-2R)的表达。采用配对t检验进行统计学分析结果：口腔癌术后外周静脉血CD8 杀伤／抑制性T细胞显著减少，CD4 ／CD8 细胞比值显著升高，CDl9 总B淋巴细胞明显升高．CDl6 /CD56 NK细胞显著减少．TNF-α的表达明显减少，其余变化无显著性差异：结论：手术虽然影响口腔癌患者的免疫功能，但减轻肿瘤患者的免疫抑制状态。术后辅助治疗尤其是免疫治疗．对口腔癌患者具有重要意义，     

胃肠减压在口腔癌根治同期修复重建患者中的应用

目的探讨口腔癌根治同期修复重建术应用胃肠减压的临床效果。 方法选择中山大学附属口腔医院口腔颌面外科行口腔癌根治同期修复重建术患者230例。2010年12月至2013年2月住院手术患者115例为非胃肠减压组,术后未行胃肠减压,于术后第1天予留置胃管并进行鼻饲流质。2013年3月至2014年8月住院手术患者115例为持续胃肠减压组,于术中进行留置胃管,术后即予持续胃肠减压,术后第1天予鼻饲流质。统计持续胃肠减压组与非胃肠减压组术后恶心呃逆、呕吐、返流误吸及吸入性肺炎的发生率,采用卡方检验或Fisher确切概率法比较分析即刻持续胃肠减压在口腔癌根治同期修复重建患者中的作用。 结果非胃肠减压组术后出现恶心呃逆17例（14.78%）、呕吐26例（22.61%）、吸入性肺炎2例（1.74%）。持续胃肠减压组术后出现恶心呃逆5例（4.35%）、呕吐2例（1.74%）,未出现吸入性肺炎。持续胃肠减压组采用即刻持续胃肠减压方法后,其术后呕吐（χ² = 23.410,P = 0.003）,恶心呃逆（χ² = 7.238,P = 0.008）与胃肠反应发生率（χ² = 33.120,P = 0.005）均低于非胃肠减压组,差异有统计学意义。 结论口腔癌根治和修复重建手术患者术后给予持续胃肠减压可减少患者术后恶心呃逆、呕吐的发生,预防术后创口感染,利于皮瓣成活,并可通过引流液性质和引流量动态观察患者术后口内创口渗血情况,及时发现病情的变化,有利于患者安全。     

Masticatory efficiency before and after surgery in oral cancer patients: comparative study of glossectomy, marginal mandibulectomy and segmental mandibulectomy

This study evaluated the effect of oral cancer surgery on masticatory efficiency. Masticatory efficiency was measured using the ATP absorption method. Eating ability was measured using a questionnaire. Two groups were employed as controls: The "normal occlusion group" consisted of subjects who had a complete set of natural maxillary teeth opposed to mandibular teeth, and the "unilateral occlusion group" consisted of subjects who had lost their molar and premolar teeth on one side of the mandible as a result of caries or periodontal diseases. Three treatment groups, each of 6 patients, were studied: a glossectomy group, a marginal mandibulectomy group and a segmental mandibulectomy group. There were no differences in masticatory efficiency between two control groups. Masticatory efficiencies of the three oral cancer treatment groups were lower than in the unilateral occlusion group, even 12 months after surgery. Masticatory efficiency of the glossectomy group was significantly higher 12 months after surgery compared with pre-surgery. Masticatory and eating abilities of the marginal mandibulectomy group and the segmental mandibulectomy were reduced at 3 and 6 months after surgery. The masticatory efficiency 12 months after surgery was higher in the marginal mandibulectomy group than the segmental mandibulectomy group, although the difference was not statistically significant. The self assessed eating ability 12 months after surgery was significantly higher in the marginal mandibulectomy group than the segmental mandibulectomy group. These results suggest that discontinuation of the mandible may lead patients to eat only foods that do not require a substantial amount of chewing. Hence, the quality of life of patients in the marginal mandibulectomy group was considered to be better than that in the segmental mandibulectomy group.     

盐酸纳布啡超前镇痛对老年口腔颌面部肿瘤手术患者的影响

目的 评估盐酸纳布啡在老年口腔颌面部肿瘤患者手术中超前镇痛的临床效果。方法 选取全麻下行口腔颌面部肿瘤手术的老年患者100例,随机分为纳布啡组（N组）和常规组（C组）。N组于麻醉诱导前10 min静脉注射纳布啡超前镇痛,C组注射等量生理盐水作为对照。记录术后1、2、6、12、24 h的VAS疼痛评分,记录2组术后不良反应及追加镇痛药物情况。采用SPSS 22.0软件包对数据进行统计学分析。结果 纳布啡组患者术后6、12、24 h的VAS评分显著低于常规组（P<0.05）,纳布啡组患者术后不良反应的发生率也显著低于常规组（P<0.05）,术后镇痛药物追加剂量少于常规组。结论 纳布啡超前镇痛可加强老年口腔颌面部肿瘤手术患者术后镇痛效果,减少不良反应的发生。     

Evaluation of novel adhesive film containing ketorolac for post-surgery pain control: a safety and efficacy study

Background: Prescribing analgesics after periodontal surgery is a common practice. However, it can become a challenge for patients with systemic diseases or who are on long‐term medications. Ketorolac tromethamine (KT), a non‐steroidal anti‐inflammatory drug, is incorporated into an adhesive film to overcome the limitations associated with oral, intravenous, intramuscular, or sublingual routes of drug administration. This study evaluates the analgesic effect of a KT adhesive film for pain management after periodontal surgery. Methods: Aqueous solvents of two bioadhesive polymers (hydroxypropyl methylcellulose and polyacrylic acid), together with 30 mg of KT, were used to formulate the adhesive film. Sixty‐eight patients, who each received a free gingival graft, were randomly divided into treatment and control groups. In the treatment group, the prepared adhesive film was applied over the surgical site, whereas in the control group adhesive film without KT was placed initially. Two hours after surgery, the KT adhesive film was applied on the surgical site in the control group. A visual analog scale was used to assess the degree of pain encountered at 0, 1, 2, 3, 4, 5, 24, and 48 hours post‐surgery. Results: The treatment group reported a significant reduction of pain intensity during the first 2 hours after surgery (P <0.05). After the KT adhesive film was applied in the control group, pain intensity was reduced to a non‐significant level by the third hour after surgery. No adverse reaction or undesirable gastrointestinal side effect was observed. Conclusion: Adhesive film containing 30 mg of KT was effective in controlling post‐surgical pain with no observable gastrointestinal effects.     

加速康复外科在口腔癌患者术后早期康复中的应用效果评价

目的: 探讨加速康复外科（enhanced recovery after surgery, ERAS）在口腔癌患者术后早期康复中的应用效果。方法: 将2016年1月—2017年12月收治的90例口腔癌患者随机分为2组,试验组45例,术后行ERAS护理;对照组45例,术后给予常规护理。比较2组患者术后3 d日均睡眠时间,中度及以上疼痛及口臭发生情况;首次下床时间、术后住院时间;术后1、3 d前白蛋白等实验室指标。采用SPSS 17.0软件包对数据进行统计学分析。结果: ERAS干预后,术后1、3 d营养指标下降低于对照组;患者首次下床活动时间、术后住院天数均短于对照组,术后3 d睡眠时间长于对照组;发生口臭、伤口感染、中度疼痛的人次数低于对照组,差异有统计学意义（P<0.05）。结论: 口腔癌患者术后实施ERAS护理,可以提高患者舒适度,改善临床结局,促进患者快速康复,具有较好的临床应用前景。     

Are postoperative intravenous antibiotics necessary after bimaxillary orthognathic surgery? A prospective, randomized, double-blind, placebo-controlled clinical trial

Postoperative antibiotic prophylaxis is often administered intravenously, despite an increased morbidity rate compared with oral application. This study investigates whether a postoperative oral antibiotic regimen is as effective as incorporation of intravenous antibiotics after bimaxillary orthognathic surgery. 42 patients who underwent bimaxillary orthognathic surgery between December 2008 and May 2010 were randomly allocated to 2 placebo-controlled postoperative antibiotic prophylaxis groups. Group 1 received oral amoxicillin 500 mg three times daily; group 2 received intravenous ampicillin 1 g four times daily, during the first two postoperative days. Both groups subsequently took oral amoxicillin for three more days. Clinically, the infection rate was assessed in both study groups for a period of 6 weeks after the surgery. 9 patients (21.4%) developed infection. No adverse drug event was detected. No significant difference (p = 0.45) was detected in the infection rate between group 1 (3/21) and group 2 (6/21). Age, type of surgical procedures, duration of the operative procedure, surgical procedure-related events, blood loss, and blood transfusion were all found not related to infection (p > 0.05). Administration of more cost-effective oral antibiotic prophylaxis, which causes less comorbidity, can be considered to be safe in bimaxillary orthognathic surgery with segmentalizations.     

种植牙术后全身与局部用药对PCT、CRP的影响及治疗效果研究

目的:探讨口腔种植牙术后全身与局部抗感染对降钙素原(PCT)、C-反应蛋白(CRP)的影响及治疗效果,为临床研究提供参考依据。方法:选择2014年1月~2015年11月120例行口腔种植牙的患者作为研究对象,采用随机数字表法分为全身组与局部组各60例,在常规治疗基础上全身组给予奥硝唑治疗,局部组在制备好的种植窝洞内及切口部位给予盐酸米诺环素治疗。于治疗前及治疗后3 d抽取静脉血检测PCT、CRP水平,并比较两组术后疼痛及疗效差异。结果:局部组总有效率95.0%明显高于全身组83.3%,差异有统计学意义(P<0.05)。局部组疼痛发生率41.7%比例明显低于全身组60.0%,差异有统计学意义(P<0.05)。结论:口腔种植牙行局部抗感染治疗疗效及止痛效果明显好于全身治疗患者。     

Psychologic response of the edentulous patient after primary surgery for oral cancer: A cross-sectional study.

STATEMENT OF PROBLEM: Edentulous patients can have difficulty in tolerating dentures and this may lead to psychologic disturbance. The problem is potentially more severe for edentulous patients after primary surgery for oral cancer, where treatment can include composite resection and reconstruction, followed by adjuvant radiotherapy. PURPOSE: This study investigated the psychologic response and oral satisfaction of edentulous patients treated by surgery for oral squamous cell carcinoma, and to make a comparison to edentulous noncancer counterparts. METHODS AND MATERIAL: The cross-sectional study included patients who were alive and disease-free 2 to 3 years after primary surgery. Seventy patients underwent surgery at the Regional Maxillofacial Unit, Liverpool, in 1993 and 1994. Twenty-eight patients were disease-free; 26 completed questionnaires that included a general health questionnaire (GHQ), a body satisfaction scale, a self-esteem scale, an oral symptom checklist, and a denture satisfaction questionnaire. Comparison was made with 98 noncancer edentulous patients from the same unit. RESULTS: There were similarities in psychologic and oral satisfaction scores between the noncancer and cancer edentulous patients. Cancer patients reported lower self-esteem (P <.02). Cancer patients who were not rehabilitated with either conventional or implant-retained prostheses had significant psychologic morbidity as measured by the GHQ, self-esteem, and body satisfaction scales. Cancer patients with implant-retained overdentures reported greater satisfaction with their dentures compared with their counterparts who wore conventional dentures (P <.05). CONCLUSION: Edentulous cancer patients who do not achieve oral rehabilitation after surgery for oral cancer exhibited significant psychologic morbidity. Patients with implant-retained overdentures exhibited a tendency to adopt the same psychologic response with improved denture satisfaction as edentulous patients with conventional dentures, despite the former having more extensive disease that would otherwise make the provision of dentures much more difficult if implants were not used.