口腔癌联合根治术后患者插胃管的护理体会

口腔癌联合根治术是指将口腔颌面部原发癌瘤与颈部淋巴组织同期整体切除的手术方式 ,是口腔颌面外科常见手术之一 ,但其创伤大 ,常引起进食障碍而影响患者营养的吸收和机体的恢复。为了更好地补充营养 ,又避免食物经过口腔影响伤口愈合 ,给患者插管尤为重要。此类病人因术后咽部水肿、伤口肿痛、痰多以及病人耐受能力差等原因常造成插胃管困难。现将我院自 2 0 0 0年 1～ 4月给 34例患者插胃管的体会报告如下。临床资料1 一般资料　本组 34例患者中 ,男 2 3例 ,年龄 2 6～ 71岁 ;女 11例 ,年龄 38～ 6 9岁。其中舌癌 2 0例 ,牙龈癌 5例 ,颊…     

口腔癌术后吞咽困难的相关因素、评估方法及术后护理

口腔癌是一种常见的恶性肿瘤,手术及相关治疗都易导致术后发生吞咽困难,极大地影响患者生活质量及预后.因此,准确诊断和及时治疗吞咽困难非常重要.本文针对目前口腔癌手术致吞咽困难的相关因素及临床上常见的评估方法、护理手段作一综述,为口腔癌术后吞咽困难患者的功能恢复提供重要参考.     

口腔癌术后并发多脏器功能不全综合征1例

严重感染、休克和大手术等可并发全身多脏器功能不全综合征（简称ＭＯＤＳ）,而口腔颌面外科手术并发本综合征者临床上鲜见。笔者近期收治１例口底癌患者,术后并发ＭＯＤＳ,经抢救治疗痊愈出院,现报告如下：１病例报告 患者刘某某,男, ５５岁因口底癌术后复发（ＲＴ４Ｎ１ｂＭ０）于２０００－０４－１６入院,随后在全麻下行口底—颌—颈联合根治术、胸大肌肌皮瓣修补术、气管切开术,术后伤口严重感染、肌皮瓣坏死,继而又行清创术,切除坏死的肌皮瓣,术后并发应激性溃疡、左下肺肺炎,呼吸急促,呼吸性碱中毒,同时还出现血压下降…     

rhEGF对口腔癌联合根治术创面愈合的影响

目的:观察rhEGF(金因肽)对口腔癌联合根治术及颈阔肌皮瓣修复组织缺损创面愈合的促进作用.方法:50例口腔癌病例(舌癌、颊癌、口底癌)分为实验组(24例)和对照组(26例),所有病例均行口腔癌联合根治术 颈阔肌皮瓣修复组织缺损,术后治疗相同,实验组加用rhEGF喷雾口内和颈部创面,而对照组不用.术后第9 d观察两组创面愈合时间及愈合率.结果:对照组愈合时间为口内12.4 d,颈部10.6 d,愈合率73.07%,实验组愈合时间为口内9.3 d,颈部7.9 d,愈合率95.83%,两组病例经统计学处理均有显著性差异(P＜0.05).结论:rhEGF对口腔癌联合根治术所造成的巨大创面的愈合及颈阔肌皮瓣的成活具有促进作用.     

胸大肌肌皮瓣修复口腔癌术后缺损并发症原因分析

目的:分析胸大肌肌皮瓣修复口腔癌术后缺损出现并发症的原因。方法:对40例晚期口腔癌患者行扩大根治术后采用胸大肌肌皮瓣修复口内组织缺损,对出现并发症的原因进行总结分析。结果:1例皮瓣部分坏死(2.5%),2例术后伤口裂开形成颏下瘘管(5%),2例颈部伤口感染(5%)。结论:细致的手术操作,术中充分止血,术后通畅的引流及口腔护理可有效避免并发症的发生,提高胸大肌肌皮瓣的移植成活率。     

微孔多聚糖止血球对口腔癌联合根治术创面止血效果的研究

研究微孔多聚糖止血球对口腔癌联合根治术创面渗血的止血效果。方法：40例行口腔癌联合根治术患者,随机分为两组,对照组采用结扎,电凝,纱布加压等常规止血方法对手术创面止血,实验组在上述常规外科手术方法的基础上加用微孔多聚糖止血球作为术中创面止血剂,记录手术出血量,输血量,术后引流量及血常规等指标,比较其间的差异。结果：实验组和对照组在年龄、性别、疾病类型、创面总出血量、输血量、第1d、2d、3d和5d的引流量和术后血常规等变量上无明显差异（P〉0．05）,在第4d引流量及1周的总引流量等方面,实验组明显低于对照组（P均〈0．05）。结论：口腔癌联合根治术后创面的处理方法对术后引流量有直接影响,微孔多聚糖止血球可以加强常规外科止血方法的效果,明显减少术后引流量。     

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。     

口腔癌的放射治疗

早期口腔癌单用放疗或手术常有同等良好的疗效。对大部分中晚期口腔癌患者,放疗作为综合序列治疗的组成部分,在术前、术中和术后应用,能改善局部控制率,对部分肿瘤有降低远处转移率的意义。因病期过晚、复发和无法手术的患者可以单独应用放疗,也可与手术、化疗联合应用,以达到减瘤和延长生存期的姑息性疗效。放疗新设备、新技术和新方法(超分割放疗、三维适形放疗与调强放疗、现代近距离放疗、同期放化疗等)的应用与放射治疗效果的提高有关。作者对口腔癌的术后放疗、颈部放疗、组织瓣和钛板整复后的放疗作了重点评述。     

口腔颌面部鳞状细胞癌患者围手术期输血与术后切口感染的关系

目的探讨口腔颌面部鳞状细胞癌(鳞癌)患者围手术期输血与术后切口感染之间的关系。方法对753例T2期鳞癌患者进行回顾性分析。结果753例中有182例围手术期未输血,术后切口感染率为3.9%,571例进行了围手术期输血,术后切口感染率为8.4%,两者之间比较有显著性差异(P<0.05);且口腔颌面鳞癌患者术后切口感染率随围手术期输血量的增大而增加。结论口腔颌面部鳞癌患者围手术期输血会增加术后切口感染并发症的发生,临床医师应合理输血。     

Factors affecting surgical mortality of oral squamous cell carcinoma resection

Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes. This systematic review aims to identify the causes of mortalities, determine both the modifiable and non-modifiable factors involved and target a reduction in postoperative 30-day mortality. In May 2019, a comprehensive search of key databases including PubMed, EMBASE, Cochrane Library was conducted. Blinded selection by two researchers identified papers that included participants who received oral squamous cell carcinoma resection and suffered an in-hospital or 30-day mortality. Selection identified two relevant papers that meet the inclusion criteria. One study had one death in its population sample but only had the cause of death described. Another study had an overall surgical mortality rate of 1% in a population of 21,681. Patients with multiple factors had the highest mortality rates; 4.6% in patients >85 years old and have a T4 diagnosis, 3.9% in patients with a Comorbidity Index ≥1 and a T4 diagnosis. These studies did not determine relationships between factors and causes of death. There are significant knowledge gaps in the literature, that can be addressed through further population analysis studies.     

Quantification of betel quid chewing and cigarette smoking in oral cancer patients

Background: Betel quid chewing and cigarette smoking are two of the risk factors for some dental diseases as well as oral cavity cancer in Taiwan. The aim of the study was to quantify these factors in oral cavity cancer patients and compare the prevalence of these factors in patients and the general population. Methods: A questionnaire was designed to evaluate betel quid chewing, cigarette smoking and alcohol drinking in 254 patients, who had squamous cell carcinoma of the oral cavity, and had received surgical excision at the Changhua Christian Hospital in Taiwan between 2005 and 2008. The results were compared with those of population of Taiwan, based on a nation‐wide survey with sample of 26 744 people. Results: We found that more than 80% of the male patients were both betel quid chewers and smokers. Few women in the survey practiced betel quid chewing, cigarette smoking or alcohol drinking. Chewers and smokers usually started the habits in their 20s. On average, a chewer patient consumed 12 508 betel quid pieces per year, for 23.3 years before the diagnosis of oral cavity cancer, making the total amount of betel quid consumed nearly 310 000 pieces; and a smoker patient consumed 469 packs per year, for 28.5 years before diagnosis, making the total number of about 14 000 packs. Patients with both habits had the age at diagnosis 4 years earlier than the smoker‐only patients, 5 years earlier than the chewer‐only patients, and 6 years earlier than those with neither. Conclusions: On average, it took two decades of betel quid chewing and cigarette smoking before oral cavity cancer diagnosis, making the life‐time consumption of these substances an astonishing amount. Betel quid chewing and cigarette smoking patients are more likely to be diagnosed with oral cavity cancer at a younger age than those who have just one habit or none. Patients that smoke more are not only more likely to be diagnosed at a younger age, but also at an advanced stage.     

Quality of life in oral cancer patients - Effects of mandible resection and socio-cultural aspects

Introduction

The aim of this study was to assess the postoperative quality of life in oral cancer patients depending on different mandible resection types and to collect information about their socio-cultural situation.

Material and methods

In this cross-sectional study, patients with primary oral cancer treated with different types of mandibular resection in the Clinic of Oral and Maxillofacial Surgery at the University of Kiel between 1997 and 2007 were included. Quality of life was assessed by means of the EORTC QLQ-C30 and H&N 35 questionnaires. Furthermore, a questionnaire about the socio-cultural background of the patients was applied. To be included, at least one year had to be passed after tumour resection.

Results

111 of 235 questionnaires were returned (47%). Significant differences in quality of life were found between patients with soft tissue resections and bone resections. There were significant worse values for continuity resections compared to only partial resections. Sixty-seven patients (60.4%) had a graduation of an elementary school as the highest school graduation, four patients (3%) had no school graduation.

Conclusions

The postoperative quality of life in our patients was significantly influenced by the extent of bone resection. This should be considered for surgical planning. The socio-cultural data showed a rather low education level for the majority of the patients.     

Quality of life in patients with oral cancer treated by different reconstruction methods as measured by the EORTC QLQ-H&N43

This was a prospective clinical study and the purpose was to assess the quality of life (QoL) as the primary endpoint for patients given prospective treatment for cancer of the oral cavity that required reconstruction using various reconstruction methods in Azerbaijan. All patients who were operated on during the year 2017 to 2018 were entered into the study. Quality of life was assessed six months postoperatively using the European Organization for Research and Cancer Treatment Core Cancer Quality of Life (EORTC QLQ-C30) and the Head and Neck Specific Quality of Life (QLQ-H&NN43) questionnaires. A total of 96 patients completed the questionnaires. There were 36 patients who did not receive a flap, 31 patients received a local flap, and 29 patients had distant-regional flaps. QoL assessed by the EORTC QLQ-C30, and the QLQ-H&N43 was lower in patients who received a local flap. In general, the results showed that the reconstruction with a distant-regional flap compared with no flap and local flap leads to improved quality of life of patients with oral cancer.     

口腔颌面部间隙感染患者预后不良的影响因素分析

目的 ：探讨口腔颌面部间隙感染患者不良结局的发生情况及相关影响因素,为其治疗和预防提供参考。方法 ：选择长沙市第四医院2011年1月—2020年6月收治的口腔颌面部间隙感染的患者为研究对象。通过医院信息管理系统（hospital information system,HIS）收集患者的临床资料,采用描述流行病学分析方法进行分析,采用单因素分析和多因素Logistic线性回归方法对口腔颌面部间隙感染患者不良结局的相关影响因素进行分析。结果：共收集到249例口腔颌面部间隙感染患者的临床资料,其中32例出现不良结局,发生率为12.85%,其中发生相关严重并发症27例、放弃治疗3例、死亡2例。多因素Logistic回归分析结果显示,年龄越大（OR=0.563）、感染至就诊时间越长（OR=1.324）、累及间隙越多（OR=0.441）、呼吸困难（OR=1.715）、合并糖尿病（OR=2.261）、中性粒细胞计数>0.9×109/L(OR=1.505)、C-反应蛋白≥10 mg/mL(OR=2.231)是口腔颌面部间隙感染患者发生不良结局的危险因素。结论：口腔颌面部间隙感染患者不良结局的发生...     

High prevalence of hepatitis C virus antibody and RNA in patients with oral cancer

We have investigated the correlation between the prevalence of hepatitis C virus (HCV), which is detectable in saliva, and oral cancer and other digestive tract cancers in the Northern Kyushu region of Japan. Anti-HCV antibodies were detected in sera from 24 of the 100 patients with oral cancer (24%, p<0.05 vs the control group, p<0.01 vs the stomach cancer group), in 11 of 104 patients with non-malignant diseases receiving dental treatment (the control group, 10.6%), and in 12 of 113 patients with stomach cancer (10.6%). HCV-RNA was detected in sera from 17 of 100 oral cancer patients (17%, p<0.05 vs the control group) and 4 of 104 patients of the control group (3.9%). These results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.     

口腔黏膜病患者口腔念珠菌感染情况的分析

目的 分析了解口腔黏膜病患者感染白念珠菌的情况。方法 收集2019年就诊于口腔黏膜科并进行白念珠菌培养的2 289 例患者,收集其基本信息、临床资料及实验室检查情况。按年龄分组:0～16岁(1组,38例),17～29岁(2组,181例),30～39岁(3组,274例),40～49岁(4组,325例),50～59岁(5组,535例),60～69岁(6组,540例),70岁及以上(7组,396例)。结果 白念珠菌总感染率为 30.6%,且女性患者感染率高于男性(33.1% vs.25.1%,P<0.05)。随着年龄的增长,白念珠菌感染率总体是上升的,且第6、7组感染率明显高于第2、3、4、5组(P<0.05)。除了口腔念珠菌病本身,唇舌疾病及口腔斑纹类疾病中最容易检测出白念珠菌,且白念珠菌的阳性检出与唇舌疾病、干燥综合征、口腔斑纹类疾病等相关。在同时进行白念珠菌培养及真菌镜检且白念珠菌培养阳性的患者中,真菌镜检阳性为50例,阳性率为35.5%。对白念珠菌培养阳性患者进行制霉素片及2%～3%碳酸氢钠溶液的局部治疗,其药物有效率为81.36%。结论 口腔念珠菌病更容易发生于60岁以上老年女性;且与系统性疾病、口腔斑纹类疾病相关。制霉素片联合2%～3%碳酸氢钠溶液局部治疗口腔念珠菌病效果尚可。