80岁以上高龄口腔颌面部恶性肿瘤患者手术治疗的回顾性分析
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摘要
背景与目的:随着人口老龄化趋势日益明显,高龄患者口腔恶性肿瘤的比例也在升高,目前主要治疗方法仍为手术治疗。该研究旨在评估80岁以上口腔颌面部恶性肿瘤患者的手术方式及治疗效果,为临床治疗提供参考。方法:回顾性分析2013年1月—2017年8月经青岛大学附属医院口腔颌面外科手术治疗的139例80岁以上老年口腔颌面部恶性肿瘤患者的临床资料,包括术前评估、手术风险、围手术期并发症等。结果:139例患者平均年龄为84.3(80~98)岁,其中鳞状细胞癌患者占78.4%,均顺利行扩大切除手术治疗,其主要修复方式为局部随意瓣(滑行瓣、旋转瓣等)、带蒂皮瓣[胸大肌皮瓣(pectoralis major myocutaneous flap,PMMF)、颏下岛状瓣(submentalental island flap,SMIF)等]及游离皮瓣移植[股前外侧游离皮瓣(anterolateral thigh flap,ALTF)及前臂游离皮瓣(radial forearm free flap,RFFF)]。无围手术期死亡患者,术后并发症发生率为26.6%。结论:年龄不是手术禁忌,根据术前评估和高龄患者手术耐受性决定手术方案的设计,80岁以上患者仍可接受彻底根治性手术和修复重建术,恢复外形和功能同期完成,获得了良好的手术治疗效果。
Background and purpose: With the aging of population, the percentage of the elderly patients with oral and maxillofacial cancers increased year by year. The main treatment method is surgery. In this study, we aimed to evaluate effects of surgery in patients aged 80 and older with oral and maxillofacial cancers. Methods: The clinical data were collected from 139 patients with oral and maxillofacial malignant cancers from Jan. 2013 to Aug. 2017 in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University, including preoperative evaluation, operation risk, perioperative complications. Results: Among the 139 cases, the average age was 84.3(80-98) years, squamous cell carcinoma accounted for 78.4%. Patients received surgical procedures, and the major repair methods included random flap(sliding flap and rotation flap), pedicle flap [pectoralis major myocutaneous flap and submentalental island flap(SMIF)], and free flap transplantation [anterolateral thigh flap(ALTF) and radial forearm free flap(RFFF)]. No patient died. The incidence of postoperative complications was 26.6%. Conclusion: Age should not be considered a contraindication by itself. The proper preoperative assessment and operative tolerance could determine the surgical options, and good therapeutic effects can be achieved in patients aged 80 and older with oral and maxillofacial cancers.
Background and purpose: With the aging of population, the percentage of the elderly patients with oral and maxillofacial cancers increased year by year. The main treatment method is surgery. In this study, we aimed to evaluate effects of surgery in patients aged 80 and older with oral and maxillofacial cancers. Methods: The clinical data were collected from 139 patients with oral and maxillofacial malignant cancers from Jan. 2013 to Aug. 2017 in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University, including preoperative evaluation, operation risk, perioperative complications. Results: Among the 139 cases, the average age was 84.3(80-98) years, squamous cell carcinoma accounted for 78.4%. Patients received surgical procedures, and the major repair methods included random flap(sliding flap and rotation flap), pedicle flap [pectoralis major myocutaneous flap and submentalental island flap(SMIF)], and free flap transplantation [anterolateral thigh flap(ALTF) and radial forearm free flap(RFFF)]. No patient died. The incidence of postoperative complications was 26.6%. Conclusion: Age should not be considered a contraindication by itself. The proper preoperative assessment and operative tolerance could determine the surgical options, and good therapeutic effects can be achieved in patients aged 80 and older with oral and maxillofacial cancers.
引文
[1]黄毅,佟晓光.中国人口老龄化现状分析[J].中国老年学杂志,2012,32(21):4853-4855.
[2]王志刚,张汝飞,王君.人口老龄化描述指标体系的构建[J].统计与决策,2015,13(16):26-28.
[3]张陈平,张志愿,邱蔚六,等.口腔颌面部缺损的修复重建——1973例临床分析[J].中国修复重建外科杂志,2005,19(10):773-776.
[4]OWENS W D,FELTS J A,SPITZNAGEL E L Jr.ASA physical status classifications:a study of consistency of ratings[J].Anesthesiology,1978,49(4):239-243.
[5]BUMPOUS J M.Treatment of stageⅢandⅣsupraglottic carcinoma:should elderly patients undergo standard treatment protocols?[J].Arch Otolaryngol Head Neck Surg,1999,125(12):1402-1404;discussion 1406-1407.
[6]ZABRODSKY M,CALABRESE L,TOSONI A,et al.Major surgery in elderly head and neck cancer patients:immediate and long-term surgical results and complication rates[J].Surg Oncol,2004,13(4):249-255.
[7]SARRIS E G,HARRINGTON K J,SAIF M W,et al.Multimodal treatment strategies for elderly patients with head and neck cancer[J].Cancer Treat Rev,2014,40(3):465-475.
[8]GRAMMATICA A,PIAZZA C,PADERNO A,et al.Free flaps in head and neck reconstruction after oncologic surgery:expected outcomes in the elderly[J].Otolaryngol Head Neck Surg,2015,152(5):796-802.
[9]PIAZZA C,GRAMMATICA A,PADERNO A,et al.Microvascular head and neck reconstruction in the elderly:the University of Brescia experience[J].Head Neck,2016,38(Suppl 1):1488-1492.
[10]HWANG K,LEE J P,YOO S Y,et al.Relationships of comorbidities and old age with postoperative complications of head and neck free flaps:a review[J].J Plast Reconstr Aesthet Surg,2016,69(12):1627-1635.
[11]ROGERS S,KENYON P,LOWE D,et al.The relation between health-related quality of life,past medical history,and American Society of Anesthesiologists'ASA grade in patients having primary operations for oral and oropharyngeal cancer[J].Br J Oral Maxillofac Surg,2005,43(2):134-143.
[12]CHEN X F,CHEN Y M,GOKAVARAPU S,et al.Free flap reconstruction for patients aged 85 years and over with head and neck cancer:clinical considerations for comprehensive care[J].Br J Oral Maxillofac Surg,2017,55(8):793-797.
[13]WESTER J L,LINDAU R H,WAX M K.Efficacy of free flap reconstruction of the head and neck in patients 90 years and older[J].JAMA Otolaryngol Head Neck Surg,2013,139(1):49-53.
[14]BHAMA P K,PATEL S A,KHAN U,et al.Head and neck free flap reconstruction in patients older than 80 years[J].J Reconstr Microsurg,2014,30(8):523-530.
[15]DIMOVSKA E O,CLIBBON J J,MONCRIEFF M D,et al.Microsurgical reconstructions for head and neck cancers in elderly aged>80 years:an analysis of surgical outcomes and quality of life[J].Ann Surg Oncol,2016,23(5):1684-1692.
[16]YANG R,LUBEK J E,DYALRAM D,et al.Head and neck cancer surgery in an elderly patient population:a retrospective review[J].Int J Oral Maxillofac Surg,2014,43(12):1413-1417.
[17]KIM H,KIM S D,SHIM Y J,et al.Is there any age cutoff to treat elderly patients with head and neck cancer?Comparing with septuagenarians and octogenarians[J].J Korean Med Sci,2016,31(8):1300-1306.
[18]SARINI J,FOURNIER C,LEFEBVRE J L,et al.Head and neck squamous cell carcinoma in elderly patients:a longterm retrospective review of 273 cases[J].Arch Otolaryngol Head Neck Surg,2001,127(9):1089-1092.
[2]王志刚,张汝飞,王君.人口老龄化描述指标体系的构建[J].统计与决策,2015,13(16):26-28.
[3]张陈平,张志愿,邱蔚六,等.口腔颌面部缺损的修复重建——1973例临床分析[J].中国修复重建外科杂志,2005,19(10):773-776.
[4]OWENS W D,FELTS J A,SPITZNAGEL E L Jr.ASA physical status classifications:a study of consistency of ratings[J].Anesthesiology,1978,49(4):239-243.
[5]BUMPOUS J M.Treatment of stageⅢandⅣsupraglottic carcinoma:should elderly patients undergo standard treatment protocols?[J].Arch Otolaryngol Head Neck Surg,1999,125(12):1402-1404;discussion 1406-1407.
[6]ZABRODSKY M,CALABRESE L,TOSONI A,et al.Major surgery in elderly head and neck cancer patients:immediate and long-term surgical results and complication rates[J].Surg Oncol,2004,13(4):249-255.
[7]SARRIS E G,HARRINGTON K J,SAIF M W,et al.Multimodal treatment strategies for elderly patients with head and neck cancer[J].Cancer Treat Rev,2014,40(3):465-475.
[8]GRAMMATICA A,PIAZZA C,PADERNO A,et al.Free flaps in head and neck reconstruction after oncologic surgery:expected outcomes in the elderly[J].Otolaryngol Head Neck Surg,2015,152(5):796-802.
[9]PIAZZA C,GRAMMATICA A,PADERNO A,et al.Microvascular head and neck reconstruction in the elderly:the University of Brescia experience[J].Head Neck,2016,38(Suppl 1):1488-1492.
[10]HWANG K,LEE J P,YOO S Y,et al.Relationships of comorbidities and old age with postoperative complications of head and neck free flaps:a review[J].J Plast Reconstr Aesthet Surg,2016,69(12):1627-1635.
[11]ROGERS S,KENYON P,LOWE D,et al.The relation between health-related quality of life,past medical history,and American Society of Anesthesiologists'ASA grade in patients having primary operations for oral and oropharyngeal cancer[J].Br J Oral Maxillofac Surg,2005,43(2):134-143.
[12]CHEN X F,CHEN Y M,GOKAVARAPU S,et al.Free flap reconstruction for patients aged 85 years and over with head and neck cancer:clinical considerations for comprehensive care[J].Br J Oral Maxillofac Surg,2017,55(8):793-797.
[13]WESTER J L,LINDAU R H,WAX M K.Efficacy of free flap reconstruction of the head and neck in patients 90 years and older[J].JAMA Otolaryngol Head Neck Surg,2013,139(1):49-53.
[14]BHAMA P K,PATEL S A,KHAN U,et al.Head and neck free flap reconstruction in patients older than 80 years[J].J Reconstr Microsurg,2014,30(8):523-530.
[15]DIMOVSKA E O,CLIBBON J J,MONCRIEFF M D,et al.Microsurgical reconstructions for head and neck cancers in elderly aged>80 years:an analysis of surgical outcomes and quality of life[J].Ann Surg Oncol,2016,23(5):1684-1692.
[16]YANG R,LUBEK J E,DYALRAM D,et al.Head and neck cancer surgery in an elderly patient population:a retrospective review[J].Int J Oral Maxillofac Surg,2014,43(12):1413-1417.
[17]KIM H,KIM S D,SHIM Y J,et al.Is there any age cutoff to treat elderly patients with head and neck cancer?Comparing with septuagenarians and octogenarians[J].J Korean Med Sci,2016,31(8):1300-1306.
[18]SARINI J,FOURNIER C,LEFEBVRE J L,et al.Head and neck squamous cell carcinoma in elderly patients:a longterm retrospective review of 273 cases[J].Arch Otolaryngol Head Neck Surg,2001,127(9):1089-1092.