Quality of life,psychological wellbeing and treatment needs of trauma and head and neck cancer patients

There is increasing evidence that patients treated for trauma or cancer of the head and neck may go on to experience psychological distress. We aimed to measure the impact of this on their quality of life (QoL) and to explore their willingness to be referred for psychological support. A total of 96 patients with facial injuries and 124 with cancer of the head and neck completed a self-reported questionnaire to identify psychological distress (Hospital Anxiety and Depression Scale (HADS) and the Acute Stress Disorder (ASD) Scale), quality of life (WHOQoL-BREF), satisfaction with treatment, and willingness to accept psychological support. Thirty-nine percent of patients showed high levels of depressive symptoms and 43% reported high levels of anxiety; 43% in the trauma group and 12% in the cancer group had high ASD scores. Patients with high scores on the HADS reported poorer QoL, and 40% of those with high levels of psychological distress were willing to consider psychological support. Despite the fact that patients report high levels of satisfaction with their medical and surgical care, many have psychological problems and have needs that are not being met. A large proportion would use psychological support services.     

前臂皮瓣和股前外侧皮瓣修复对舌鳞癌术后缺损老年患者生活质量的影响

目的 比较前臂皮瓣和股前外侧皮瓣修复对舌鳞状细胞癌术后缺损老年患者生活质量的影响。方法 对我院口腔科就诊的行股前外侧皮瓣或前臂皮瓣修复舌鳞状细胞癌术后缺损的129例老年患者临床资料行回顾性分析,其中股前外侧皮瓣组81例,前臂皮瓣组48例。应用华盛顿大学生命质量问卷（The University of Washington Quality of Life,UW-QOL）和口腔健康影响程度量表（the 14-item Oral Health Impact Profile questionnaires,OHIP-14）调查并比较患者术后 6、12个月的生活质量差异。结果 两组患者肿瘤切除方式差异具有统计学意义（P<0.05）。组内不同时间点比较,生活质量评价所有指标均得到显著改善。UW-QOL结果显示,两组术后6和12个月总分比较差异均无统计学意义（P>0.05）。OHIP-14结果显示,术后6个月股前外侧皮瓣组总分显著小于前臂皮瓣组（P<0.05）,术后12个月总分比较差异无统计学意义（P>0.05）。结论 两组舌鳞癌老年患者术后 12个月生活质量无显著差异,建议舌部分切除时选择前臂皮瓣修复,舌全切除时选择股前外侧皮瓣修复。     

股前外侧穿支皮瓣修复口腔癌术后缺损患者的生活质量评估

目的 评估应用游离股前外侧穿支皮瓣（ALTF）修复口腔颌面部恶性肿瘤切除术后组织缺损患者的生活质量（QOL）。方法 以2012年1月-2013年7月应用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损的32例患者为研究对象,应用口腔健康影响程度量表（OHIP-14）和简明健康状况调查问卷（SF-36）对患者术后12个月的QOL进行调查和评估。结果 SF-36问卷得分位于前3的项目是躯体疼痛、生理功能和躯体角色,得分分别是78.58±14.82、72.08±27.86和60.00±42.63;得分较低的是情感角色（41.67±39.62）、心理健康（50.75±13.07）和健康变化（54.17±21.75）。分析OHIP-14量表得分,恢复较好的项目是社交障碍和残障,得分分别为34.50±11.32和36.04±12.05;恢复较差的项目是生理性疼痛和心理不适,得分分别为73.50±18.96和60.17±25.66。结论 采用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损,能够恢复患者外形、语言和咀嚼功能的基本需求,提高患者的QOL。     

Health-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap

Objectives: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Mandibular resection has been associated with a poor health-related quality of life (HRQOL), particularly before free fibula flap to reconstruct the defect. The aim of this study was to evaluate health-related quality of life in patients who have had mandibular resections of oral cancer and reconstruction with free fibula flap. Study Designs: There were 115 consecutive patients between 2008 and 2011 who were treated by primary surgery for oral squamous cell carcinoma, 34 patients had a mandibular resection. HRQOL was assessed by means of the 14-item Oral Health Impact Profile (OHIP-14) and University of Washington Quality of Life (UW-QOL) questionnaires after 12 months postoperatively. Results: In the UW-QOL the best-scoring domain was mood, whereas the lowest scores were for chewing and saliva. In the OHIP-14 the lowest-scoring domain was social disability, followed by handicap, and psychological disability. Conclusions: Mandible reconstruction with free fibula flap would have significantly influenced on patients’quality of life and oral functions. The socio-cultural data show a fairly low level of education for the majority of patients. Key words:Health-related quality of life, free fibula flap, mandibulectomy, UW-QOL, OHIP-14.     

延长锁骨上岛状皮瓣在修复舌鳞状细胞癌术后缺损中的应用

目的 评价延长锁骨上岛状皮瓣(extended supraclavicular fasciocutaneous island flap,eSIF)修复舌癌术后缺损的可靠性.方法 22例经病理证实的舌癌患者,男17例,女5例,年龄26～73岁,平均(52.9±12.4)岁.应用eSIF修复,皮岛面积(4 cm×6 cm)～(8 cm×14 cm),平均5.5 cm×8.7 cm.结果 20例皮瓣成活率91%(20/22),其中2例皮瓣边缘坏死.舌外形恢复,语音、吞咽功能良好;瘢痕隐蔽,肩功能运动不受影响.随访观察5～16个月,18例生存良好;2例术后半年对侧颈淋巴结转移,经挽救性手术,目前仍存活;2例患者分别于术后8和10个月死于远处转移.结论 eSIF是修复舌癌术后缺损的可靠方法.

Abstract：

Objective To assess the reliability and usefulness of the extended supraclavicular fasciocutaneous island flap (eSIF)for reconstructing soft tissue defects followinng tongue cancer ablation.Methods Twenty-two tongue defects in 22 patients with tongue cancer were repaired with eSIF after resection of the tongue malignant tumours. The sizes of the skin paddle ranged from ( 4 cm× 6 cm ) to (8 cm× 14 cm)( average: 5.5 cm × 8.7 cm). Results The eSIF survived in twenty cases, including two cases with minimal partial necrosis. The patients were follwed up for 5-16 months. Eighteen patients were alive with disease free,two were alive with disease and two died of a lung and liver metastasis. Conclusions The eSIF is reliable for reconstructing oral defects following the ablation of advanced oral malignant tumors.     

腹直肌-腹膜瓣修复舌缺损的临床研究

目的 探讨腹直肌-腹膜瓣修复舌缺损的临床效果。方法2003年9月至2004年4月，5例舌癌患者接受了舌癌联合根治术同期腹直肌-腹膜瓣修复术。腹直肌．腹膜瓣包括腹直肌、腹直肌后鞘、腹膜、肋间神经及腹壁下动静脉。术中将肋间神经与舌下神经降支吻合。结果全部腹直肌-腹膜瓣成活。术后随访至今，无严重并发症，再造舌外形及活动度满意，语音、吞咽功能接近正常。术后2个月组织学检查证实腹膜上皮化。结论腹直肌-腹膜瓣行半舌再造的初步临床效果满意。     

降下唇肌瓣与髂骨移植联合修复进展期口底癌术后缺损

目的:探讨应用降下唇肌瓣与髂骨移植联合修复进展期口底癌术后缺损的方法和效果。方法 :在2011-08—2013-05,对于5例进展期口底癌患者行肿瘤扩大切除术,遗留的口底和下颌骨缺损采用降下唇肌瓣与髂骨移植联合修复。通过观察组织瓣成活、舌活动度和面部外形等情况,评价其修复效果。结果:随访2¹8个月,组织瓣全部成活,舌活动度良好,面部外形良好,活动义齿修复下颌缺牙,咀嚼功能恢复良好。结论:降下唇肌瓣和髂骨移植,制备方法简便,均不需要吻合血管,两者联合应用是修复进展期口底癌术后缺损的理想方法。     

50例老年舌癌患者围手术期护理

目的：探讨老年舌癌患者围手术期的护理方法。方法：对50例老年舌癌患者做好心理护理，严格术前准备，术后严密观察病情变化，做好呼吸系统、口腔及饮食护理，对实施皮瓣移植修复的患者做好并发症观察。结果：50例老年舌癌患者通过实施肿瘤切除和颈部淋巴结清扫术，加游离皮瓣移植修复及围手术期的护理，全部成功。结论：对老年舌癌患者在围手术期实施有效的护理方法至关重要，是促进患者尽早康复提升生命质量的重要措施。     

Evaluation of swallowing function after intraoral soft tissue reconstruction with microvascular free flaps

This study assessed swallowing function after tumour resection and reconstruction utilizing free vascularized flap closures in patients with oral cancer. Swallowing function was evaluated postoperatively in 23 patients (21 men and 2 women) who had undergone reconstruction with either a lateral upper arm free flap (LUFF, n=16) or a radial forearm free flap (RFFF, n=7). Videofluoroscopy was used to assess tongue mobility and abnormalities of swallowing function.All patients who underwent reconstruction with LUFF or RFFF free flaps had decreased tongue mobility, except for the tip of the tongue. Patients who underwent anterior or posterior resection had greater decreases in tongue mobility than those who underwent medial resection. Swallowing impairment was similar in patients with LUFFs and those with RFFFs. Anterior resection of the oral cavity had a significant negative effect on swallowing function. Silent aspiration occurred in five patients. In conclusion the resection site affected swallowing function, but the type of flap did not, in patients with oral carcinoma, who underwent tumour resection with reconstruction     

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目的探讨前臂游离皮瓣修复舌癌术后缺损的临床应用。方法选择2005年6月至2009年10月惠州市惠阳区人民医院口腔科舌鳞状细胞癌患者26例,采用舌癌联合根治术中同期行前臂游离皮瓣移植修复术治疗,并对治疗效果进行随访观察。结果本组26例患者皮瓣均完全成活,供、受区创口均一期愈合,所有患者修复后舌形态功能恢复良好。结论对舌癌联合根治术造成的舌缺损,应用前臂游离皮瓣修复的临床效果较好,重建后的舌功能恢复也较为理想。     

舌癌患者术后语音功能的影响因素分析

目的：评价舌癌患者手术前、后的语音功能,探讨患者术后语音功能的影响因素。方法：收集2001年10月—2004年6月在上海交通大学医学院附属第九人民医院口腔颌面外科I病区接受手术的舌癌患者27例,所有患者的舌切除范围均在半舌内。根据重建术式分为前臂游离皮瓣修复组（16例）、邻近舌组织瓣修复组（11例）;根据肿瘤大小和分期分为T1组（9例）、T2组（13例）及T3组（5例）;根据肿瘤切除后缺损的部位分为舌前部切除组（5例）、舌中部切除组（6例）、舌后部切除组（12例）和半舌切除组（4例）;根据术后舌活动度分为I度受限（14例）、Ⅱ度受限（7例）和Ⅲ度受限（6例）。采用100个具有代表性的汉字组成的汉语语音清晰度测试字表作为检测手段,对每例患者手术前、后语音清晰度变化情况进行采样,利用SPSS11.5软件包对所获资料进行方差分析,评价原发灶大小、手术切除部位、修复术式、邻近结构保存以及术后舌活动度等因素对患者术后语音清晰度的影响。结果：前臂游离皮瓣组和邻近舌组织瓣修复组间,术后语音清晰度比较无显著性差异（P〉0.05）;对原发灶大小不同的舌癌患者术后语音清晰度的比较表明,T1和T3组间有显著性差异（P〈0.05）;舌前份切除者的语音清晰度显著低于后份切除者（P〈0.05）,保存舌尖和口底组术后的语音清晰度明显高于未保存组（P〈0.05）,保存舌根组和未保存组间的语音清晰度改变无显著差异（P〉0.05）;不同程度伸舌受限者,术后语音清晰度下降有显著差异（P〈0.01）。结论：对半舌范围内行舌切除的舌癌患者,手术切除部位和邻近结构以及舌活动度的保存与否是影响术后语音功能的敏感因素,原发灶大小在一定程度上决定术后语音清晰度的高低,而选择何种修复手段并不是其主要影响因素。     

不同舌重建术后患者语音功能的评价

目的:评价不同舌重建术式对舌癌患者术后语音功能恢复的影响。方法:32例舌癌患者据重建术式分组:带蒂胸大肌肌皮瓣修复组5人,除1例外舌切除缘范围均过中线;前臂游离皮瓣修复组和邻近组织瓣修复组分别为16人和11人,除1例外舌切除缘范围均不过中线。采用汉语语音清晰度测试和短句测试方法,对患者手术前后语音清晰度变化情况进行分析,并对前臂游离皮瓣修复组和邻近组织瓣修复组的评价结果进行团体t检验。结果:带蒂胸大肌肌皮瓣修复组、前臂游离皮瓣修复组和邻近组织瓣修复组术后的语音清晰度平均下降值分别为26.60、7.84和4.18分,短句测试得分下降值分别为1.60、0.50和0.27分;t检验结果显示,前臂皮瓣和邻近组织瓣修复组的语音清晰度和短句测试得分下降值间无显著性差异(P>0.05)。结论:舌癌手术切除后运用前臂游离皮瓣或邻近组织瓣进行舌重建均能较好地恢复患者术后的语音功能,且两者间没有显著差异;对于舌缺损范围较大尤其是超过半侧舌的患者,采用带蒂胸大肌皮瓣也能够在一定程度上改善患者术后的语音功能。     

下颌骨区段缺损术后骨性重建对生活质量的影响

目的分析口腔癌患者下颌骨区段缺损术后骨性重建对生活质量（quality of life,QOL）的影响。方法17例因口腔癌而致下颌骨区段切除的患者按重建术式的不同分为骨性重建组和非骨性重建组,同时采用SF-36、FACT-H＆N和UW-QOL三种量表分别在术前、术后3个月和术后12个月进行生活质量的测量,比较两组患者生活质量的差异及纵向变化趋势。结果两组患者术前生活质量的差异无显著性,而在术后3个月和术后12个月两个时点,骨性重建组均有较好的外貌、进食、功能状况和总体生活质量（P〈0.05）。术后12个月时,骨性重建组的生活质量恢复到了接近术前水平,而非骨性重建组仍遗留有较严重的口腔相关的特异性问题和较差的功能状况。结论下颌骨区段缺损后的骨性重建能改善患者的外形和功能,提高患者术后的QOL,值得在临床上推广使用。     

舌癌根治性切除行前臂游离皮瓣修复重建的功能评价

目的 :对舌癌患者行舌颈联合根治术,同期行前臂游离皮瓣移植舌再造后,中远期的语音、咀嚼、吞咽等功能恢复情况的观察和初步评价。方法:对我院2008—2013年间,175例行舌(颌)颈联合根治术,同期应用血管化前臂游离皮瓣即时修复舌缺损的患者,按手术切除范围的不同分为3组(I组手术切除≤半舌,II组手术切除舌根或部分舌根,III组手术切除半舌及同侧口底),分别进行2年以上时间的随访。通过语言清晰度测定、咀嚼效率测定、舌运动范围的测量、吞咽造影剂透视显示吞咽模式,对患者修复后的舌形态、运动功能、语言功能、咀嚼功能、吞咽功能等进行评价。结果:本组175例患者语音清晰度良好,但因舌缺损范围的不同,语音清晰度有一定的差别,舌体活动范围III组较其他2组受限明显,而咀嚼效率无明显差异,吞咽功能异常主要表现在启动障碍和造影剂滞留/残留。结论:本研究结果显示前臂皮瓣修复舌缺损,尤其对≤半舌或伴有部分口底缺损的修复,能够获得良好的功能恢复,值得临床继续使用。     

前臂尺侧游离皮瓣在舌再造中的应用

目的：探讨用前臂尺侧游离皮瓣修复舌缺损的效果及切取皮瓣后对手功能的影响,方法：对15例舌癌术后用前臂尺侧游离皮瓣即刻修复舌缺损,术后观察成功率,舌的外形,活动度及粘膜化情况,对手术前后左右手小指及无名指的两点触觉进行比较。结果：15例用前臂尺侧游离皮瓣修复舌缺损的皮瓣全部成活,舌外形,活动度及粘膜化均满意,术前和术后双手小指和无名指二点触觉及痛觉未见明显差异,而10例桡侧皮瓣的患者中有3例半年内拇指和食指有不同程度的感觉迟钝,结论．：前臂尺侧游离皮瓣由于位置较桡侧隐蔽,质地更细腻,切取后对拇指及食指掌侧的感觉功能无影响,该皮瓣不失为舌缺损修复再造的首选皮瓣之一。     

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

Background

To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap.

Material and Methods

The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery.

Results

Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05).

Conclusions

Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity.     

前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的应用

目的:总结前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的临床效果。方法:选择舌癌联合根治术+同期前臂游离皮瓣移植修复术治疗的患者39例,对临床治疗效果进行随访观察。结果:随访6个月～4年,全部病例供、受区创口均一期愈合,患者语言、吞咽等功能均满意。结论:前臂游离皮瓣修复是舌癌术后组织缺损修复与功能重建较为理想的选择。     

Reconstruction of the tongue using an extended vertical lower trapezius island myocutaneous flap after removal of advanced tongue cancer

In this study we explored an effective method to repair defects in the tongue that had been produced during removal of advanced tongue cancer. Eighteen patients with advanced squamous cell carcinoma of the tongue were treated, and extended vertical lower trapezius island myocutaneous flaps based on the transverse cervical artery were used to repair more than half the tongue. No flap failed completely and no shoulder was affected. The lingual contours were excellent. The functional results in terms of speech and swallowing were satisfactory. The patients were followed up for 6 to 24 months. Three of them were alive with disease and two have died of the local recurrence or metastasis at 18 and 20 months, respectively. The extended vertical lower trapezius island myocutaneous flap is a large, simple, and reliable flap, which is preferred for reconstruction of defects of the tongue after removal of advanced tongue cancer.     

口腔癌根治术后经游离皮瓣修复口腔缺损的感觉恢复效果探讨

目的 :考察游离皮瓣修复口腔癌术后口腔缺损的感觉恢复情况。方法 :回顾我院13例经游离皮瓣修复口腔缺损的口腔癌患者,按照其皮瓣位置分为A组(游离前臂皮瓣)及B组(游离腓骨肌皮瓣),对其术后6个月和12个月时修复区的感觉恢复情况进行评价。结果:6个月时,12例患者的感觉功能开始恢复,且以触觉和痛觉最先恢复。所有患者12个月时的感觉恢复程度均优于6个月时,表明皮瓣修复区的感觉恢复至少需6个月以上的时间。结论:游离前臂皮瓣、游离腓骨肌皮瓣对患者感觉功能的恢复作用相仿,均能够有效改善患者生存质量。     

累及相邻器官的晚期舌癌的手术治疗:附1例报告

报告1例晚期舌癌患者实施多器官联合切除同期双游离瓣修复术,术中切除全舌、双侧口底、右下颌骨及左下颌骨颏部、部分右上颌骨、右软腭、右扁桃体、会厌、舌骨及全喉,制备右腓骨肌瓣、左腹直肌肌皮瓣移植修复软硬组织复合缺损,临床疗效满意。推荐对晚期口腔癌患者施行救治性外科及重建。