口腔癌患者术后吞咽障碍危险因素的系统评价

通过系统评价的方法探究口腔癌患者术后吞咽障碍的危险因素。     

右美托咪定对口腔癌术后患者留置气管导管耐受性的影响

目的:探讨右美托咪定对口腔癌术后患者留置气管导管耐受性的影响.方法:选取口腔癌手术患者80例,随机分为正常对照组(N组)和右美托咪定组(D组),每组各40例.2组均行常规麻醉诱导和维持,D组于麻醉诱导前给予1μg/kg负荷剂量的右美托咪定,术中泵注0.2～0.6μg/(kg·h)右美托咪定维持麻醉,术毕镇痛泵内给予1μ...     

前哨淋巴结活检判断口腔癌颈部淋巴结转移的系统评价

目的:系统评价前哨淋巴结活检(SLNB)预测口腔癌颈淋巴结转移的临床价值。方法:通过计算机检索CENTRAL、Medline、EMBASE、IFCC、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(CQVIP)、万方数据库等,收集应用前哨淋巴结活检判断口腔癌颈淋巴转移的诊断试验,应用统计软件Meta-DiSc 1.4进行数据分析。结果:纳入分析的文献9篇,前哨淋巴结活检判断口腔癌颈淋巴转移的敏感度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及系统接收操作特性曲线(SROC)下面积分别为84%(95%CI 73%～92%)、100%(95%CI97%～100%)、19.16(95%CI 7.65～47.77)、0.22(95%CI 0.10～0.51)、97.72(95%CI 29.69～321.61)和0.99。结论:前哨淋巴结活检可作为临床上判断口腔癌颈淋巴结转移有效可行的方法。     

146例口腔癌患者术后生存质量评价

目的探讨口腔癌患者术后生存质量的变化及其影响因素。方法通过对术后6个月的146例患者华盛顿大学生存质量问卷调查而分析生存质量的变化及影响因素。结果术后患者总体生活质量下降，术后T3、T4组、N0、N1组、颌骨连续性破坏组及根治性颈淋巴结清扫术组分别低于T1、T2组、N3、N4组、颌骨连续组及功能性淋巴结清扫术组。结论术后6个月时口腔癌患者生存质量下降，肿瘤大小、颈淋巴结转移、手术后颌骨的连续性、颈淋巴结清扫术式影响术后生存质量。     

晚期口腔癌患者术后家庭照顾者的需求现状

口腔癌是头颈部常见的恶性肿瘤。晚期口腔癌患者主要以手术治疗为主,由于专科护士缺乏及社区医院的供不应求,家庭照顾者需承担所有的生活照顾。知识和经验的缺乏,使得他们在照顾过程中产生了一系列需求。本文综述了照顾者的此类需求,以期为临床提供参考。     

507例气管切开的临床分析

预防性或紧急气管切开术,是口腔颌面外科医生常遇到的手术之一。我科自1965年5月～1986年11月共行气管切开507例,现就临床体会报道如下:     

微创气管切开术的临床应用与评价

目的　研究微创气管切开术的应用效果和价值。方法　 6 0例预防性气管切开患者 ,被随机等分为 2组 ,组 1采用微创技术 ,组 2采用传统技术。记录操作时间和成功率 ,操作中BIS、HR、MAP、RR和SpO2 的变化 ,以及并发症和伤口愈合情况。结果　 (1)组 1、组 2成功率均为 10 0 % ,操作时间为 (5 .6± 3.2 )min和 (9.2± 4 .1)min ,差异显著。 (2 )扩张气管壁过程中 ,组 2的BIS和MAP明显大于组 1。 (3)术后组 2出现切口疼痛和凹陷性瘢痕病例明显多于组 1。结论　微创气管切开术成功率高、操作迅速、创伤小、遗留瘢痕小 ,有更广泛应用前景。     

口腔癌患者术后吞咽障碍评价与其早期预后的相关性研究

目的 通过对口腔癌患者术后吞咽障碍的评价,观察其与口腔癌患者早期吞咽障碍预后的相关性.方法 选取2016年9月至2019年9月于辽宁中医药大学附属医院确诊并手术治疗的口腔癌患者124例,经口腔修复后进行洼田饮水试验评估及电视X线透视吞咽功能(VFSS)检查,比较两种方法评价吞咽障碍效果.根据成功随访3个月的95例患者是...     

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。     

Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery with microvascular reconstruction

The purpose of this study was to determine the relationship of early and delayed tracheostomy decannulation protocols on the length of stay, time to oral feeding and incidence of postoperative complications in patients undergoing microvascular reconstruction for oral cancer.A review of all patients who underwent surgical management of oral squamous cell carcinoma (OSCC) over the study period from 01/07/2017 to 31/06/2021 was performed. Patients who underwent elective tracheostomy as part of their microvascular reconstruction were included. Two cohorts were identified based on distinct postoperative tracheostomy decannulation protocols; early (Within 7 days) and delayed (≥7 days). Time to oral feeding, length of stay and complication rates was determined for both groups for statistical analysis.A total of 103 patients with OSCC were included in the study. The overall complication rate was 35.9% and were more likely in node positive patients (53.7% vs 23.2%; p = 0.003) and in cases where the geniohyoid muscle complex was disrupted during tumour resection (66.7% vs 31.9%; p = 0.026). Early decannulation was significantly associated with shorter length of hospital stay (10 days vs 15 days) and earlier removal of nasogastric feeding tubes (7 vs 10 days). There was no difference in the overall complication rate between the two groups (33.3% vs 37.5%; p = 0.833).Early decannulation in appropriately selected patients is recommended as it significantly reduces the length of hospital stay and aids in early resumption of oral intake. Furthermore, this approach is not associated with increased rates of complications.     

口腔癌患者内源性二氢尿嘧啶与尿嘧啶血浆浓度比值在5-Fu化疗中的应用价值

目的:探讨口腔癌患者内源性二氢尿嘧啶(UH2)与尿嘧啶(U)血浆浓度的比值及其在5-Fu化疗中的应用价值。方法:36例口腔癌患者术后给予DDP 5-Fu辅助化疗,化疗前采用高效液相色谱法检测患者血浆中UH2和U的比值(RUH2/U),并根据RUH2/U调整5-Fu的给药剂量,化疗中检测5-Fu的血药浓度并观察其毒副作用。结果:口腔癌患者RUH2/U值为2.31±1.06(0.61～5.18),其中2例RUH2/U比值低于1.0;RUH2/U值男女间存在显著性差异,而各年龄段间无显著性差异;5-Fu的给药剂量范围为0.89～3.09g/m2,患者5-Fu的血药浓度为318.96±150.62μg/L,所有患者均未出现严重的毒副作用。结论:RUH2/U大小可用于调整5-Fu的剂量,以达到5-Fu的个体化化疗。     

热灌注化疗对口腔颌面部恶性肿瘤患者NO及T淋巴细胞的影响

目的: 探讨热灌注化疗对口腔颌面部恶性肿瘤患者NO及T淋巴细胞的影响。方法: 选取汉堡大学休伯特斯·沃尔德癌症中心2017年12月—2019年12月收治的口腔颌面部恶性肿瘤患者60例,按照随机数字表法分为热化疗组(30例)与常规化疗组(30例),常规化疗组患者给予单纯静脉化疗,热化疗组患者在静脉化疗的基础上给予热化疗。比较2组患者的治疗效果、NO及T淋巴细胞数量、生存质量以及毒副反应之间的差异。采用SPSS 22.0软件包进行数据统计。结果: 热化疗组的治疗有效率及疾病控制率显著高于常规化疗组。治疗后,热化疗组患者NO含量显著高于常规化疗组,CD4⁺、CD4⁺/CD8⁺显著高于常规化疗组,热化疗组患者体力功能、情感功能、社会功能等功能性指标及综合生存质量评分显著高于常规化疗组,疲劳、疼痛、便秘等症状性指标显著低于常规化疗组,差异均具有统计学意义(P<0.05)。2组患者的毒副作用比较差异无统计学意义(P>0.05)。结论: 热化疗可显著提高口腔颌面部恶性肿瘤患者的治疗效果及NO含量,改善患者的免疫功能,提高生存质量,且安全性较高。     

Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery

In maxillofacial head and neck oncology, tracheostomy is often used to secure the airway, but not without risk. This study compared the existing practice of two units: one where tracheostomy was routinely done with one where overnight intubation was used. From both units we retrospectively analysed 50 consecutive patients who had intraoral resection, neck dissection, and microvascular reconstruction for head and neck cancer. When compared with tracheostomy, overnight intubation resulted in a shorter mean stay in the intensive therapy unit (ITU) (1.4 compared with 3.7 days), a shorter overall hospital stay (12.9 compared with 18.0 days), less time to first oral intake (8.9 compared with 12.8 days), and a lower rate of lower respiratory tract infection (LRTI) (10% compared with 38%). This study supports the discontinuation of routine tracheostomy and the adoption of a more selective practice to improve recovery.     

口腔颌面部肿瘤患者营养风险筛查和营养治疗

目的:运用营养风险筛查(NRS2002)对口腔颌面部肿瘤患者进行营养风险筛查,评估NRS2002在口腔颌面部肿瘤患者中的应用情况;同时对筛查出具有营养风险的患者进行肠内营养治疗,观察治疗效果。方法:收集59例口腔颌面部肿瘤住院患者为研究对象,询问病史、近期进食情况及体重变化情况,测量身高、体重,并测定血红蛋白、淋巴细胞计数、血清白蛋白和前白蛋白。参照NRS2002对患者的具体要求,在手术前和手术后1d及7d分别对患者进行营养风险筛查。将术后筛查出有营养风险的患者随机分为实验组与对照组,进行营养干预。比较营养治疗7d后各项生化指标的变化。采用SPSS11.5软件包对结果进行t检验和χ2检验。结果:术前患者营养风险的检出率为27.1%,术后1d则提高到71.2%。与术前相比,术后营养风险显著上升(P<0.05),且患者血红蛋白、淋巴细胞计数、血清白蛋白、前白蛋白在术后均有显著下降(P<0.01)。营养干预前,实验组与对照组营养生化指标无显著性差异(P>0.05);营养干预7d后,对照组患者血液生化指标中除血红蛋白略有下降外,淋巴细胞计数、血清白蛋白、前白蛋白较干预前略有上升,其中前白蛋白显著升高(P<0.05)。实验组患者血液生化指标除血红蛋白略有下降外,淋巴细胞计数、血清白蛋白、前白蛋白较干预前均显著提高(P<0.05);营养干预后,再次进行营养风险筛查发现,与对照组相比,实验组干预后的NRS2002评分显著下降(P<0.05)。结论:NRS2002能方便、快捷地反映口腔颌面部肿瘤住院患者手术前的营养风险,且术后有针对性的营养治疗能显著提高患者的营养状况,减少感染性并发症,改善预后。     

基于德尔菲法构建老年口腔癌患者围术期口腔护理方案

目的 构建老年口腔癌患者围术期口腔护理方案。方法 在前期指南内容分析、医护患相关人群深入访谈的基础上,根据老年口腔癌患者的临床特点、治疗阶段,结合PDCA循环,构建老年口腔癌患者围术期口腔护理方案初稿,采用德尔菲法对16位相关领域专家进行2轮函询,以确定方案。采用Excel 2016、SPSS 25.0软件包进行统计描述和统计分析。结果 2轮专家咨询回收率均为100%,整体专家权威系数为0.84。经过2轮专家咨询,各指标的变异系数为0~0.240,整体协调系数为0.171,形成了术前、术后、放化疗时期3个阶段的口腔护理方案。术前阶段包括4个维度,12个一级条目,56个二级条目;术后阶段包括4个维度,18个一级条目,102个二级条目;放化疗阶段包括4个维度,13个一级条目,35个二级条目。结论 老年口腔癌患者围术期口腔护理方案符合老年口腔癌围术期患者特点,能够满足该群体的口腔护理需求,方案构建具有可靠性,能为临床实践提供参考。     

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-SG...     

Predictive factor for photodynamic therapy effects on oral squamous cell carcinoma and oral epithelial dysplasia

Objective

The aim of this study was to investigate the correlation between the immunohistochemical expression of proliferating cell nuclear antigen (PCNA), factor VIII, and CD34 (markers of endothelial cells), and vascular endothelial growth factor (VEGF) and the recurrence of oral squamous cell carcinoma (OSCC) and oral epithelial dysplasia (OED) subjected to photodynamic therapy (PDT).

Design

Twenty-one biopsy specimens (14 cases of OSCC and 7 cases of OED) before PDT were immunohistochemically investigated in terms of their expressions of PCNA, factor VIII, CD34 and VEGF. The percentages of the total sample area that were immunopositive for factor VIII (percentage factor VIII immunopositive area: PFIA) CD34 (PCIA) and VEGF (PVIA) were calculated using computer-assisted image analysis for quantitative assessment of endothelial cells or VEGF expression in the lesions. The PCNA labelling index (LI) was evaluated as a proliferation marker.

Results

Five cases of OSCC and one case of OED recurred 4 to 30 months after PDT. We found that the average PVIA was 14.5% in the no-recurrence group and 1.7% in the recurrence group. The difference between these values was statistically significant (P = 0.0483). On the other hand, the average PCNA LI was 30.3% in the no-recurrence group and 24.3% in the recurrence group; the average PFIA was 3.7% in the no-recurrence group and 1.6% in the recurrence group; and the average PCIA was 2.0% in the no-recurrence group and 1.4% in the recurrence group. There were no significant differences between the two groups for any of these markers (P = 0.3379, P = 0.1195, P = 0.4835, respectively).

Conclusions

These results provide clinical data indicating that VEGF expression may be a useful predictive marker for the effects of PDT in OSCC and OED.     

Surgical outcomes of T4b oral cancers: assessment of prognostic factors and a need to re-evaluate the current staging system

T4b oral cancer is a broad umbrella term for all advanced oral cancers, the prognosis of which varies drastically for disease of the same stage, according to the extent of the masticator space involvement. This was a retrospective observational study including all consecutive T4b oral squamous cell carcinoma patients treated surgically between January 2015 and January 2016 and followed up until January 2020. The disease was classified as upper disease or lower disease based on the anatomical location in relation to an imaginary plane passing through the base of the retromolar trigone. The prime objective was to evaluate overall survival and prognostic factors affecting overall survival. The projected 5-year overall and disease-free survival rates were 40.7% and 35.6%, respectively. The assessment of prognostic factors revealed that lower disease (lower anatomical subsites), bone invasion, and lymph nodal spread significantly affected survival. Patients with disease in an upper anatomical location without bone and nodal involvement can achieve fairly good survival (projected 5-year overall survival of 64.2%) when compared to the other subsets of patients. We propose a re-evaluation of the current staging system based on the prognostic features, so that all patients are not considered under a single stage, since their survival differs significantly.