口腔颌面肿瘤总论(二).ppt

口腔颌面部肿瘤总论(二) 季 彤 上海第二医科大学 口腔医学院 附属第九人民医院 口腔颌面外科 口腔颌面肿瘤的治疗 治疗原则 治疗方法 手术、放射治疗 、化疗、生物治疗、其它 口腔颌面肿瘤的预防 口腔颌面部肿瘤的治疗 治疗原则 综合治疗 个体化方案（individualization） 因人因病　量体裁衣 根治外科和功能外科并重 良性肿瘤：手术治疗 恶性肿瘤：综合序列治疗 combined and sequential therapy 化疗＋手术＋放疗＋其它 　　根据组织来源、细胞分化程度、肿瘤生长部位、临床分期(TNM)及全身情况选择 组织来源 来源不同，治疗方法不同 上皮来源　　　间叶来源 淋巴造血系统 骨肉瘤 细胞分化分化好—手术分化差—放、化疗 生长部位颅底、深部、重要结构—功能障碍面部、皮肤、颌骨肿瘤—手术 临床分期 早期 晚期—综合治疗 TNM分期(UICC) 全身情况 口腔颌面部肿瘤的治疗方法 手术治疗(Surgery) 根治术与功能外科的概念，无瘤原则 放射治疗(Radiation therapy) 化疗(Chemotherapy) 生物治疗(Biotherapy) 免疫治疗(Immunotherapy) 手术治疗原则 明确诊断 明确手术作用，制定合理治疗方案 诊断，探查，治愈，姑息，修复重建，预防 全面考虑，选择合理术式 保存性功能性外科 (conservative functional surgery) 修复性功能性外科 (reconstructive functional surgery) 防止医源播散 无瘤原则 切缘在正常组织内 整块切除（en bloc） 避免挤压 肿瘤表面纱布覆盖 使用电刀 冲洗更换器械 根治与功能并重 Radiation Therapy Prof. Rontgen – X ray Prof. Marie Curie – Radium element Definition – ionizing radiation Component of multi-modality therapy Increasing use for head and neck cancer Principle Radiation sensitive Types of radiation therapy External beam(外照射) vs. Brachytherapy(腔内照射) Common complications General Principle Basis – ionizing(电离) particles interact with cellular molecules Damages DNA impossible for the cells to grow Damages both cancer and normal cells, the latter are able to repair themselves Used to: Combined or as single modality Treat localized tumors Treat leukemia and lymphoma Rapidly dividing cell populations are the most sensitive to radiation tumors, epithelial cells, hemopoietic cells(造血细胞) Complications Acute Tissue Reactions Late Tissue Reactions Acute Toxicity Mucosal reactions – 2nd week of XRT Mucositis Skin reactions – 5th week Generally subside several weeks after completion of treatment Late Toxicity Injury tends to be permanent Develop within months to years Xerostomia(口干症), radionecrosis of bone, dental caries, fibrosis, soft-tissue necrosis, nerve tissue damage Chemotherapy One of the main technologies against cancer Definition N