口腔鳞癌术后复发相关因素的临床研究

目的:研究分析影响口腔鳞癌预后的临床病理因素。方法:对673例原发口腔鳞癌患者以病变部位、肿瘤生长类型、临床T分期、局部淋巴结转移、治疗方式、术后病理分级以及下颌骨切除方式等指标来研究与口腔鳞癌预后相关的因素。结果:口腔鳞癌术后的复发率与病变部位、肿瘤的生长类型、肿瘤的T分期、区域淋巴结转移及病理分级等因素有关,与治疗方式及颌骨切除方式等因素无关。结论:临床工作中,我们应综合分析各种临床病理因素。对与术后复发率关系较为密切的因素要进行仔细评估,制定出有效的预防措施,提高口腔鳞癌的手术治愈率及生存率。     

口腔黏膜鳞癌术后复发相关因素的观察和研究

目的：分析影响口腔鳞癌预后及复发的临床病理因素,为进行综合治疗及其预后评价提供临床依据。方法：对407例原发口腔鳞癌患者以病变部位、肿瘤厚度、临床T分期、区域淋巴结转移、治疗方式、手术方式、术后组织学分级等指标研究与口腔鳞癌术后及复发相关的因素。结果：口腔鳞癌术后的复发率与病变部位、肿瘤厚度、临床T分期、区域淋巴结转移及组织学分级等因素有关,诱导化疗联合手术的综合治疗可有效降低口腔鳞癌的复发率。结论：临床工作中,我们应综合分析各种临床病理因素,对与术后复发关系较为密切的因素进行仔细评估,制定出有效的预防措施,提高口腔鳞癌的手术治愈率及生存率,降低复发率。     

晚期口腔鳞癌患者独立预后因素及生存预测模型的建立

目的 探讨晚期口腔鳞癌患者的独立预后因素并构建生存预测模型。方法 收集117例晚期口腔鳞癌患者的一般资料及既往病史,所有患者均行口腔鳞癌切除术并联合放疗,根据患者情况进行羟基喜树碱及平阳霉素化疗。所有患者随访时间为手术结束至术后5年,记录患者生存情况,分析晚期口腔鳞癌患者预后的独立危险因素。采用SPSS 20.0软件包对数据进行统计学分析。结果 随访期间,2例因其他原因死亡,4例因失访而剔除。剩余111例患者中, 42例死亡,69例存活,生存率为62.16%;年龄、T分期及M分期不同的晚期口腔鳞癌患者生存情况无显著差异（P>0.05）;性别、组织分化程度、N分期及化疗情况不同的晚期口腔鳞癌患者生存情况差异显著（P<0.05）;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗是晚期口腔鳞癌患者生存情况的独立危险因素（P<0.05）;组织分化程度不是晚期口腔鳞癌患者生存情况的独立危险因素（P>0.05）;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗的生存曲线对晚期口腔鳞癌患者生存情况具有一定预测作用。结论 性别、N分期及是否联合羟基喜树碱与平阳霉素化疗是晚期口腔鳞癌患者生存情况的独立危险因素;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗的生存曲线,可作为晚期口腔鳞癌患者的生存预测模型。     

口腔癌手术放疗后慢性疼痛及应用游离脂肪移植防治前景

晚期口腔鳞癌患者治疗后的慢性疼痛关注度低,有效防治方案匮乏,游离脂肪移植有缓解疼痛、改善美观等作用,对于提高晚期口腔鳞癌患者术后生存质量具有极大应用潜力.     

晚期口腔和口咽恶性肿瘤治疗后影响吞咽的因素

口腔及口咽肿瘤治疗后往往对吞咽功能造成影响,术后口腔进食能力与手术和患者相关因素有关。晚期口腔及口咽癌术后接受或不接受化放疗的114例患者,记录临床病理参数和重建方式。采用口腔进食功能评分(FOIS)对治疗前、后的数据进行比较。结果:首次获得吞咽功能的平均时间为14 d。     

口腔癌术后放疗患者口腔菌群的变化

目的　了解口腔鳞癌术后放疗对患者口腔菌群的影响,为临床防治继发感染提供实验依据。方法　32例 口腔鳞癌术后患者,于放疗前后分别在照射野的中心区域与对侧黏膜采集唾液标本,进行细菌的分离培养鉴定,测 量可培养细菌的检出率、检出量和构成比。结果　与放疗前相比,放疗后照射侧和非照射侧的链球菌属、白色念珠 菌和绿脓杆菌检出增加;而照射侧的放线菌属和奈瑟菌属检出减少(P<0·05)。结论　口腔癌术后放疗可影响口 腔的微生态平衡,是导致口腔癌术后放疗患者发生感染的重要原因之一。     

3种方法修复口腔及口咽癌术后缺损1年后生存质量分析

目的：分析3种修复方式(拉拢缝合、颏下岛状皮瓣、前臂皮瓣)修复口腔及口咽癌患者术后缺损1年后的生存质量及相关影响因素。方法对 2012年1月—2012年10月在中山大学孙逸仙纪念医院口腔颌面外科行口腔及口咽癌术后1年的47例患者进行问卷调查。采用华盛顿大学生存质量问卷第4版及欧洲癌症研究与治疗组织生存质量问卷第3版、头颈问卷第1版。将伤口直接缝合、颏下岛状瓣、前臂皮瓣修复口腔及口咽癌术后缺损分为3组后,分析不同修复方式对患者术后1年生存质量的影响。采用SPSS 20.0软件包对数据进行统计学分析。结果47例患者完成相关问卷。前臂皮瓣组在吞咽、咀嚼、语言和UW-QOL整体项中显著优于直接拉拢缝合组（P<0.05）,在UW-QOL问卷中的总分也好于后者（P<0.05）,与颏下瓣组相比,2组患者的总体生存质量无显著差异（P>0.05）;颏下瓣组在咀嚼、语言和食欲丧失项中显著好于直接拉拢缝合组（P<0.05）。结论口腔及口咽癌术后1年患者中,吞咽、语言和咀嚼成为近期患者生存质量的主要方面,术后应加强对患者进行语言和吞咽等训练。术中同期对口腔及口咽癌进行皮瓣修复,可以显著提高患者的生存质量。     

口腔鳞癌中Bax,Bcl-2和Survivin 蛋白表达与预后相关性研究

目的:研究凋亡相关蛋白Bax,Bcl-2及Survivin的表达与口腔鳞癌预后的相关性,确定预后判断的有效标志物。方法:采用免疫组织化学方法,检测110例口腔鳞癌患者术后石蜡切片组织中Bax、Bcl-2及Survivin蛋白的表达。通过目标蛋白阳性染色细胞比例和阳性细胞中蛋白的染色强度判定各种蛋白的表达水平;应用SAS 9.0软件中的Kaplan-Meier及Cox回归分析Bax、Bcl-2及Survivin蛋白表达与口腔鳞癌预后的相关性。结果:110例标本检测和统计分析结果表明,Bax、Bcl-2和Survivin蛋白单独表达水平与口腔鳞癌术后生存时间并无显著的相关性;Bcl-2/Bax的比值与口腔鳞癌的术后生存时间呈显著相关(P<0.05)。结论:口腔鳞癌患者组织标本中的Bcl-2/Bax值是影响预后的重要指标,提示该指标在临床上可作为口腔鳞癌患者预后判断的有效标志物。     

舌癌患者术后1年生存质量的相关因素分析

目的：探讨舌癌患者术后1年的生存质量变化及其相关影响因素。方法：选择2003—2005年中山大学附属第二医院口腔颌面外科手术治疗的93例舌癌患者，在术前及术后1年时，由患者自主完成华盛顿大学生存质量问卷（第4版）填写，分析生存质量的变化；利用SPSS11．5软件包进行非参数检验和多因素线性回归分析。结果：术后12个月，生存质量问卷的总体生存质量接近术前；术后12个月时，生存质量问卷的外形、行为、语言和肩部功能分值较术前显著下降，差异有统计学意义（P〈0．05）；而疼痛、抑郁和焦虑分值较术前升高，差异有统计学意义（P〈0．05）。多因素回归分析显示，临床分期、放疗、年龄、社会经济因素影响生存质量。结论：早期发现、早期治疗舌癌，提高患者的社会经济水平。对提高生存质量有重要意义。     

国际文摘

1口腔及口咽部鳞癌患者下颌骨放射性骨坏死:发生率及危险因素Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx:incidence and risk factors.Monnier Y,Broome M,Betz M,et al.Otolaryngol Head NeckSurg,2011,144(5):726-732.下颌骨放射性骨坏死(ORN)是头颈癌患者放疗后的严重并发症,该文旨在分析口腔及口咽鳞癌放疗后下颌骨ORN的发生率及危险因素。对2000-2007年间的73例口腔及口     

口腔癌患者的心理困扰及生存质量研究

目的: 探讨口腔癌患者的心理现状及其影响因素,以及与生存质量相关的因素。方法: 使用心理困扰温度计（distress themometer,DT）和华盛顿大学生存质量量表（University of Washington Quality of Life Questionnaire,UW-QOL）对郑州大学第一附属医院2016年10月—2017年9月收治的250例口腔癌患者进行问卷调查。应用SPSS20.0软件包对数据进行统计学分析。结果: 发放问卷250份,实际回收有效问卷239份。在239例口腔癌患者中,DT分数≥4分139例（58.2%）,UWQOL量表平均得分53.3±17.1;<4分的患者100例（41.8%）,UWQOL量表平均得分52.8±17.4,DT总平均得分4.56±2.18。单因素分析结果显示,心理困扰与年龄、文化程度、收入水平、病理分期、颌骨切除、复发6个因素有关（χ²值分别为5.12、21.31、34.2、10.69、31.3和7.84,P<0.05）。Logistic回归分析显示,年龄、颌骨切除、复发是影响口腔癌患者心理困扰的危险因素（OR值分别为4.06、5.12和5.79,P<0.05）。Spearman相关分析显示,UWQOL量表中疼痛、娱乐、情绪、焦虑4个条目得分与心理困扰得分呈负相关（r分别为-0.58、-0.84、-0.66和-0.69,P<0.05）。结论: 口腔癌患者的心理困扰发生率较高;年龄越小、做过颌骨切除、复发的患者心理困扰程度更严重。对口腔癌患者施行个体化的治疗方案、术后护理及心理疏导,可能会减轻患者的心理困扰程度。     

Dental esthetics and quality of life in adults with severe malocclusion before and after treatment

Objective:To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups.Materials and Methods:Fifty-two patients (36 women, 16 men; age 18–61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need.Results:Oral health–related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health–related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups.Conclusion:Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health–related quality of life, particularly by decreasing psychological discomfort and psychological disability.     

早期肠内营养支持对44例口腔口咽癌术后放化疗患者的影响

目的: 探讨放疗前2周进行肠内营养支持治疗对口腔口咽癌患者术后放化疗的营养状况及生活质量的影响。方法: 回顾性分析44例口腔口咽癌术后放化疗患者在不同时机进行营养干预后的营养状况及生活质量变化。将放疗前2周体重作为协变量,校正基线水平后,对观察指标体重、体质指数（BMI）及其与基线的变化值、主观整体营养状况评估（PG-SGA）等及生活质量评分量表（EORTC QLQ-C30及QLQ-H&N35）中整体健康状况、躯体功能和疲劳感3个方面分别进行评估。采用SPSS 19.0软件包,以重复测量方差分析分别对观察指标进行统计学分析。结果: 早期干预（即放疗开始前2周至放疗结束后2周给予肠内营养补充）25例,按需干预（即放疗3周后至放疗结束后2周给予肠内营养补充）19例。2组体重在放化疗期间整体均呈下降趋势,但早期干预组的下降程度更小（P=0.023）。2组PG-SGA在观察期间均出现较大幅度下降,早期干预组更显著（P=0.027）。2组整体健康状况总体上均好转,但患者均出现不同程度的疲劳感,躯体功能也不断下降,按需干预组更明显（P>0.05）。2组在放射性口腔黏膜炎程度分级上无统计学差异。结论: 口腔口咽癌患者术后放化疗期间的营养状况明显下降,早期肠内营养支持可在一定程度上维持体重,改善患者营养状况,但在提高患者生活质量方面未见明显优势。     

口腔扁平苔藓患者心理痛苦程度及影响因素的调查研究

目的 调查口腔扁平苔藓（OLP）患者的心理痛苦程度并分析其影响因素。方法 采用一般资料问卷、心理痛苦温度计（DT）及广泛性焦虑量表（GAD-7）对符合纳入标准的236例OLP患者进行横断面调查,采用SPSS 26.0软件对调查结果进行统计分析。结果 236例OLP患者心理痛苦得分为3.17±2.64,其中有显著心理痛苦（≥4分）的患者97例（41.1%）,轻度心理痛苦（1～3分）的患者90例（38.1%）;引起其心理痛苦的主要问题为口腔疼痛（47.5%）、担忧（41.5%）、睡眠障碍（39.4%）等;经多元线性回归分析,疾病类型（糜烂型和非糜烂型）、焦虑、年龄、无时间精力做家务、睡眠障碍、腹泻、水肿、鼻子干燥/充血是心理痛苦的独立影响因素。结论 OLP患者普遍存在不同程度的心理痛苦,糜烂型、伴有焦虑情绪和（或）睡眠障碍的患者心理痛苦程度更高。医护人员应加强对OLP患者心理痛苦的评估,及时识别存在显著心理痛苦的患者,以便采取合理有效的干预措施。     

Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation

The aim of this study was to assess changes in the quality of life and psychological distress of patients with tongue cancer undergoing total/subtotal glossectomy (TG) or extended hemiglossectomy (HG) and free flap transfer. Differences between the two groups were compared using the Short Form 8-Item Health Survey (SF-8) and Hospital Anxiety and Depression Scale (HADS). Of the 43 patients with tongue cancer, 24 (56%) underwent TG and 19 (44%) underwent HG. The general health and social functioning scores in the SF-8 and depression in the HADS were significantly worse in the TG group than in the HG group at 12 months after surgery, indicating that patients in the TG group may experience social isolation and psychological distress, and have difficulty in employability even 12 months after surgery. In contrast, all items of the SF-8 in the HG group were nearly equal to those in the general population. Due to the extensive psychological impact on patients with tongue cancer who are planned for an extended resection, curative surgery with free flap transfer and multidisciplinary psychiatric support are essential to improve quality of life and manage psychological distress.     

Psychological function in orthognathic surgical patients before and after bilateral sagittal split osteotomy with rigid and wire fixation.

A multisite randomized controlled trial was conducted to compare the psychological function of patients who undergo surgical correction of a Class II malrelation with bilateral sagittal split osteotomy with either wire or rigid fixation. Subjects were 31 male and 86 female patients referred by orthodontists. Psychopathological symptoms and psychological distress were measured with the Symptom Checklist-90 Revised at the following times: before placement of orthodontic appliances, 1 to 2 weeks presurgery, and 1 week, 8 weeks, 6 months, and 2 years postsurgery. Patients' satisfaction with their surgical outcome was measured with a 3-item questionnaire. Results showed no statistically significant differences in psychological function or satisfaction between patients treated with wire or rigid fixation. Psychological function was within normal limits immediately before surgery. Psychological parameters did not determine patient satisfaction, even among patients who met an operational definition of "psychopathological caseness." Psychological symptoms and general distress increased modestly immediately after surgery for both groups and then progressively declined over the succeeding 2 years, eventually reaching levels that were significantly lower than presurgical levels. It was concluded that (1) rigid and wire fixation do not differ in their effects on psychological function and satisfaction; (2) patients who seek orthognathic surgery for a Class II malocclusion are psychologically healthy, ie, comparable to normal populations, immediately before surgery; (3) presurgical psychological function does not determine satisfaction with surgical outcome; and (4) psychological function tends to improve during the 2 years after surgery.     

An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic

The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.     

Predictors of treatment outcomes after removal of amalgam fillings: associations between subjective symptoms,psychometric variables and mercury levels

Weidenhammer W, Bornschein S, Zilker T, Eyer F, Melchart D, Hausteiner C. Predictors of treatment outcomes after removal of amalgam fillings: associations between subjective symptoms, psychometric variables and mercury levels. Community Dent Oral Epidemiol 2010. © 2010 John Wiley & Sons A/S Abstract – Objective: This analysis aimed to study predictors of different treatment outcomes and associations between subjective symptoms, psychometric variables and mercury levels in patients who subjectively attributed their health problems to dental amalgam. Material and methods: A secondary and retrospective analysis of data of a recently published randomized clinical trial was performed. Seventy‐eight patients [44% female, mean (SD) age 35 (6) years, randomly assigned to either amalgam removal or a health promotion program] were included into statistical analysis. Prior to intervention and 12 months later, questionnaires for assessing symptoms, psychological distress and health status were presented, and mercury levels in blood and urine were determined. Results: The patients’ personality profile at study onset was characterized by slightly reduced extraversion and slightly elevated emotional instability. Overall, subjective symptoms decreased slightly and there were no statistically significant differences in the decrease of symptoms after intervention between both groups. Decrease of mercury levels after intervention was closely associated with removal of amalgam fillings (r_mult = 0.64 in regression analysis). Statistically significant correlations could be found between mercury levels and subjective symptoms with respect to baseline (r = 0.29–0.39) and to changes after intervention (r = 0.24–0.42), but not for psychological distress (r = 0.05–0.25) and health related quality of life (r = ?0.03–0.18). Prediction of symptom improvement after intervention was poor (r_mult = 0.44). Conclusions: Results contribute some new aspects to the inconsistent findings in the literature with respect to associations between symptoms and subtoxic mercury levels. More emphasis should be placed on exploring individual vulnerability for amalgam sensitivity.     

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient’s quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P < 0.01), recreation and mood (P < 0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.     

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.