GlideScope视频喉镜在口腔颌面肿瘤患者全麻经鼻气管插管的应用

目的：比较GlideScope视频喉镜与Macintosh喉镜应用于颌面部肿瘤手术患者全麻经鼻插管的过程。方法：48例口腔颌面肿瘤择期行全麻下手术患者随机分组, 给予表面麻醉及清醒镇静后分别使用两种喉镜窥视声门, 引导行经鼻腔气管插管, 记录声门暴露时间, 插管时间、 声门暴露程度、 手法辅助及气管钳使用情况、 咽部损伤分级、 插管困难模拟评分。结果： 使用Glide?Scope缩短了插管时间 ［22 （15～33） s］ 比 ［28 （16～45） s］, P=0.032。声门暴露分级更佳, 咽喉部损伤分级降低, 插管难度评分降低。结论： GlideScope视频喉镜更适用于颌面部肿瘤患者经鼻腔气管插管。     

不同修复方法修复口腔颌面部肿瘤术后缺损的效果比较

目的探讨不同修复方法修复口腔颌面部肿瘤术后缺损的效果。方法选取口腔颌面部肿瘤根治术后缺损患者89例,根据最终选取的修复方案分为A组(n=49)和B组(n=40),A组给予股前外侧嵌合皮瓣修复,B组给予串联皮瓣修复。观察2组手术情况,采用华盛顿大学头颈肿瘤生活质量量表(UW-QOL)对患者术后生活质量进行评价,检测唾液中唾液酸(SA)及癌胚抗原(CEA)水平。结果 A组手术时间、胃管拔除时间和经口进食时间分别为(6.30±1.19)h、(19.77±2.81)d和(20.32±2.19)d,明显少于B组(P<0.05);但A组皮瓣制作时间为(1.20±0.28)h,明显多于B组(P<0.05)。A组术后6个月UW-QOL量表中外观、吞咽、咀嚼、言语、肩功能、情绪评分分别为(63.29±4.54)分、(54.93±5.03)分、(47.12±6.02)分、(64.49±4.33)分、(82.20±5.43)分和(75.50±7.20)分,明显高于B组(P<0.05)。A组和B组术后6个月UW-QOL量表中疼痛、活动、娱乐、味觉、唾液及焦虑评分比较差异无统计学意义(P>...     

A standardized approach to bereavement risk-screening: a quality improvement project

Abstract

Objectives: Identifying family members at-risk of poor bereavement outcomes poses a challenge for clinicians, resulting in inconsistent bereavement follow-up. The current quality improvement study tests a method for identification of at-risk family members, and describes follow-up they received from the bereavement service at Dana-Farber Cancer Institute.

Design: A standardized bereavement risk assessment, referral and follow-up process was piloted as part of a quality improvement project using a plan-do-study-act approach (PDSA).

Methods: A convenience sample of eleven clinical social workers completed paper and pencil bereavement risk-screening assessments using the Bereavement Risk-Screening Tool (BRST) on a sample of bereaved family members known to them. The results of the BRST were passed onto the bereavement program for follow-up.

Findings: Eleven out of a total of 17 social workers participated in the study. Social workers screened 100% (52/52) of identified bereaved family members, corresponding to 52 patient deaths. Approximately half (28/52) were identified as being ‘at-risk’ of a poor bereavement outcome based on the social worker’s consideration of the presence of potential risk-factors and their response to a prediction-type question about the bereaved individual’s future coping. ‘Lack of preparation for the death’, ‘unexpected death within the context of an illness’ and ‘witnessing a difficult death’ were the most commonly identified risk factors. Of those individuals who were identified to be ‘at-risk’, 89% received an outreach attempt by telephone from the director of bereavement services, surpassing our project target of 80%.

Conclusions: The BRST has the potential to help clinicians in health care settings identify those family members who might be considered at heightened risk of a poor bereavement outcome, facilitating early outreach and recommendations for support. The tool was easy to complete and helped streamline the referral process to the bereavement program.     

口腔颌面部癌及癌旁组织端粒酶检测

[目的]研究口腔颌面部癌组织及相应癌旁组织中的端粒酶活性,探讨其作为口腔颌面部癌肿瘤标志物的可行 性及其临床意义。[方法]用银染TRAP法检测32例口腔颌面 部癌组织及其相应的32例癌旁组织、4例混合瘤、4例乳头状 瘤、2例造釉细胞瘤、5例正常口腔粘膜的端粒酶活性。[结 果]32例口腔颌面部癌组织中,有30例端粒酶活性表达阳性 ,其阳性率为93.7％。32例癌旁组织中,有2例端粒酶表达阳 性,其阳性率为6.3％。4例乳头状瘤、4例混合瘤、2例造釉 细胞瘤、5例正常口腔粘膜端粒酶表达均为阴性。口腔颌面 部癌组织端粒酶活性表达与该肿瘤的临床病理特征无明显 相关性(P>0.05)。[结论]口腔颌面部癌组织中普遍存在端粒酶 活性表达,而口腔良性肿瘤和正常口腔组织中端粒酶活性 较少表达,端粒酶可作为诊断口腔颌面部癌的肿瘤标志物 。癌旁组织端粒酶活化提示有少量肿瘤细胞,应随访以证 实。     

婴幼儿口腔颌面部血管瘤的早期手术治疗

本文通过对１０６例０～８岁婴幼儿血管瘤患者手术治疗的总结回顾，发现出生１月内患者手术有效中１００％，３～８岁内患者手术有效中８０．９％。认为手术是治疗血管瘤的主要方法，安全、可靠、并发症少，并提示血管瘤发现越早，早作手术，治疗效果越好。     

I 125放射性粒子植入在口腔颌面部恶性肿瘤治疗中的应用

  目的  研究I125放射性粒子组织间近距离植入治疗口腔颌面部恶性肿瘤的近期疗效及副反应, 探讨其在恶性肿瘤综合治疗中的应用价值。   方法  根据制定的相应放射性粒子植入治疗计划, 对38例口腔颌面部恶性肿瘤患者应用手术配合I125粒子植入治疗或单纯粒子植入治疗, 术后随访观察疗效及副反应。   结果  所有病例随访12~28个月, 平均20个月, 其中23例手术配合粒子植入者局部未见明显新生肿物, 15例单纯粒子植入病例均见病灶不同程度缩小, 不适症状有所减轻。除2例患者出现局部皮肤色素沉着, 1例患者咽部不适1周后缓解, 余病例均未出现明显粒子植入后副反应。   结论  放射性粒子植入治疗对口腔颌面部恶性肿瘤的近期疗效显著, 为综合治疗口腔颌面部恶性肿瘤提供了新的发展方向。      

Sentinel node biopsy and quality of life measures in a Chinese population

Background

Sentinel lymph node biopsy (SLNB) has become an alternative procedure of axillary lymph node dissection (ALND) with a lower risk of significant operative morbidity. The primary aim of the present study was to evaluate the morbidity and quality-of-life (QoL) after SLNB or ALND. The second aim was to analyze whether the number of SLNs removed was associated with an increased incidence of postoperative morbidity.

Methods

From Apr-2006 to Aug-2007, 140 patients treated with SLNB and 81 patients treated with ALND were enrolled in the study. Patients' data were collected preoperatively and at 1, 6, and 12 months after operation. Measurement of arm volume and shoulder function, evaluation of subjective sensory abnormality of both arms and chest wall were performed at every follow-up visit. Besides, patients were required to fill out the simplified Chinese version of the functional assessment of cancer therapy-breast questionnaire at 12 months after operation.

Results

Patients treated with SLNB suffered less morbidity compared with ALND. Elevated body mass index and ALND procedure were independent risk factors associated with postoperative lymphedema. Moreover, patients treated with wide local excision or SLNB had better QoL compared with those treated with mastectomy or ALND. No relationship was observed between the number of SLNs and the morbidity or QoL.

Conclusion

SLNB is associated with a better QoL and less morbidity compared with ALND regardless of the number of SLNs in Chinese women with breast cancer. To limit the number of SLNs less than five did not show any evidence to reduce morbidity.     

口腔颌面部126例海绵状血管瘤缝扎硬化的疗效分析

目的　观察瘤体分区缝扎硬化治疗颌面部血管瘤的疗效及不良反应。方法　采用瘤体周围及分区交叉缝扎加瘤腔内注射平阳霉素的方法,治疗颌面部海绵状血管瘤12 6例。平阳霉素术后可重复注射1～6次。结果　随访观察6～3 6个月,治愈98例,基本治愈2 6例,有效2例,无无效病例。临床治愈率(包括治愈和基本治愈)为98 4%。结论　分区缝扎硬化治疗海绵状血管瘤操作简便、安全可靠,治愈率高,特别对于唇部、舌前部、颊部易于阻断血流处治疗效果好,具有较好的治疗应用价值。     

Practice and documentation of palliative sedation: a quality improvement initiative

Background

Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu).

Methods

A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards.

Results

Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg).

Conclusions

The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area.     

口腔颌面部肿瘤患者术后发生下肢深静脉血栓的相关危险因素分析

目的 分析口腔颌面部肿瘤患者术后发生下肢深静脉血栓的相关危险因素.方法 选取口腔颌面部肿瘤术后发生下肢深静脉血栓患者52例作为发生组,并以1:1配比选取同期口腔颌面部肿瘤术后未发生下肢深静脉血栓患者52例作为未发生组,收集2组年龄、性别、体质量指数(BMI)是否超重、术后D-二聚体、术后纤维蛋白原(FIB)等临床信息,...     

Digital technologies and quality improvement in cancer surgery.

Telecommunications, multimedia and computer technologies will introduce marked changes in the management of cancer. New modalities in the representation of patient's medical records using computer technology products and services allow unlimited cross-sharing of information. Education taught through multimedia methods, and through the Internet, is available anywhere and any time just like surgical simulation, robotics and virtual reality. Thanks to computer and IT technologies, surgeons will be able to acquire, assess and validate new surgical procedures or concepts from any geographical location. Live demonstrations shared via videoconferencing facilitate mental development through the acquisition of the cognitive aspects of surgical procedures. Virtual reality is a major improvement in the processing of medical imaging. As a result, the interpretation and the simulation of therapeutic approaches to patients with cancer are facilitated through transparency, navigation and manipulation. The Internet eventually offers uninterrupted communication links between healthcare providers (teaching, training or multidisciplinary telementoring included). Computer and IT technologies will undoubtedly contribute to standardized cancer treatment modalities and determined guidelines for good clinical practice worldwide.     

Effect of a Broad-Spectrum Cephalosporin on the Oral and Intestinal Microflora in Patients Undergoing Colorectal Surgery

The influence of ceftriaxone on oral and intestinal flora was investigated in 10 patients undergoing colorectal surgery. Ceftriaxone was given intravenously in one 2g dose before anesthesia. Saliva and feces samples were collected and analyzed on day 0, 3, 5, 14 and 28 after drug administration. All specimens were cultured quantitatively for aerobic and anaerobic microorganisms; representative colonies of each morphologic type of organism cultured were identified. The oral aerobic flora was somewhat affected by the administration of ceftriaxone. In all patients the number of Streptococci, Staphylococci and Neisseria decreased during the 5 days after ceftriaxone administration. No significant changes in the number of anaerobic commensal occurred. The oral microflora of all patients after 14 days had returned to normal. The aerobic fecal flora was considerably affected: in all patients enterobacteria were eliminated or strongly suppressed. Only minor changes in the number of aerobic gram-positive bacteria were observed, and the anaerobic intestinal flora showed only minor alterations. On day 28 the intestinal flora were normalized in all respects. No new colonizing microorganisms were isolated during the investigation period and no colonization with ceftriaxone-resistant bacteria was observed. No postoperative infection occurred and no adverse effects were registered.     

口腔恶性肿瘤术后患者中医辨证分型116例分析

[目的]探讨口腔颌面部恶性肿瘤术后患者的中医辨证分型。[方法]对116例口腔恶性肿瘤术后患者进行中医辨证分型，参照《中医证候规范》及《上海市中医病证诊疗常规》，分成气阴两虚型、气血亏虚型、睥虚痰湿型、气滞血瘀型、热毒壅阻型及其他证型。[结果]116例口腔恶性肿瘤患者术后出现气阴两虚型占50．86％（59／116），同时兼有脾虚痰湿型占64．65％（75／116）：颈部淋巴结转移患者与临床各证型关系无显著性相关（P〉0．05）；气阴两虚型患者病程为7．61±5．80个月，明显长于总病例数的平均病程7．56±5．95个月（P〈0．05）。[结论]口腔恶性肿瘤患者术后中医证型以气阴两虚型为主，脾虚痰湿型其次。     

精确粒子定位植入近距离放疗辅助手术治疗34例老年口腔颌面部肿瘤分析

摘 要：［目的］ 探讨精确粒子定位植入近距离放疗辅助手术治疗老年口腔颌面部肿瘤的价值。［方法］ 采用前瞻性研究方法,2014年8月到2016年5月诊治的口腔颌面部肿瘤患者68例,根据随机信封抽签原则分为观察组与对照组各34例,对照组采用常规手术治疗,观察组采用精确粒子定位植入近距离放疗辅助手术治疗,放疗剂量30～50Gy,每次2.5Gy～3.0Gy,每周5次,共15～20次。［结果］ 治疗后观察组有效率为55.9%,明显高于对照组的29.4%(P=0.023)。治疗后观察组与对照组的疼痛评分分别为2.14±0.56分和3.78±0.61分,均明显低于治疗前的5.39±1.49分和5.62±0.98分(P<0.05),且观察组评分明显低于对照组(P<0.05)。对照组治疗后的外周血中T淋巴细胞亚群(CD4、CD8)明显低于治疗前,观察组治疗前后的CD4、CD8比较差异无统计学意义 (P<0.05),且均明显高于对照组(P<0.05)。［结论］ 精确粒子定位植入近距离放疗辅助手术治疗老年口腔颌面部肿瘤对于机体的免疫功能无明显影响,能有效发挥镇痛作用,能提高近期疗效有效率。     

Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic

Trismus can be a problematic consequence of treatment for oral and oropharyngeal cancer. The aim of this study was to investigate the relationship between trismus, subjective function and health-related quality of life, in order to postulate a clinically relevant cut-off that might be useful as an indicator of patients who might benefit from intervention. One hundred consecutive patients attending the Maxillofacial Oncology clinic at the University Hospital Aintree were assessed during a period of four months. Mouth opening was recorded in millimetres. Subjective outcomes were evaluated using UW-QOL questionnaire for chewing, saliva, mood, anxiety and overall quality of life. The median age of patients was 63 (IQR 56–69) years. The median time since treatment was 16 (IQR 6–34) months. The median mouth opening (32 mm; range 6–53, IQR 24–40) was associated strongly with clinical T stage (Tis/T1–2 35 mm, T3–4 24 mm), radiotherapy (no 38 mm, yes 27 mm) and type of primary surgery (primary closure 38 mm, soft-tissue flaps 30 mm, composite flaps 24 mm). The amount of mouth opening and of the single question (about how much less mouth opening since treatment) was significantly associated with patients perception of chewing deficit, less than full diet and less than good overall quality of life. This study supports a 35 mm cut-off for trismus. There is merit including the two elements together (opening in mm and the single item question on mouth opening since treatment) as outcome parameters