预防化疗和头颈部放射治疗并发症的癌症患者牙科护理

Davit Mathevosyan
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摘要

肿瘤疾病在人口残疾和死亡率结构中占首位。治疗颌面部恶性肿瘤患者的主要方法是外科手术、放射治疗和化学治疗。仅采用上述方法之一进行治疗的情况很少,主要是在原位癌阶段或疾病的 I 期。治疗方法取决于肿瘤的临床和形态特征,需要同时或按一定顺序使用所有方法。放疗和化疗不仅会产生全身副作用,还会对治疗区域产生副作用。在抗肿瘤治疗的背景下,伴随而来的慢性疾病(包括牙源性疾病)也会加重。口腔粘膜、皮肤、皮下组织、唾液腺和颌骨骨髓都会出现病理变化。这些结构在肿瘤治疗过程中的受损程度取决于其初始状态。同时,口腔的初始状态也会影响抗肿瘤治疗的质量。不良的口腔卫生和慢性牙源性病变会引起阵发性发热和其他全身并发症。所有这一切都要求停止或改变抗肿瘤治疗的策略,从而降低其根治性。显而易见,肿瘤医生在治疗前进行口腔卫生检查,可以避免或减少颌面部并发症的发生,提高肿瘤患者的生活质量。针对此类患者的牙科治疗有其特点,需要因人而异。本研究旨在回顾头颈部化疗和放疗引起的主要口腔组织并发症的文献。在谷歌学术、Medline、Scopus、Web of Sciences 和 PubMed 上进行了系统性综述。搜索关键词包括头颈部癌症、牙科护理、癌症并发症的预防、口腔组织病变表现、化疗、头颈部放疗。进行了初步检索,并审查了 132 篇标题和摘要,在这篇文学评论中收录了 48 篇文章。本文分析了头颈部化疗和放疗导致的口腔组织主要并发症,并对这类患者的并发症管理和预防提出了切实可行的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dental Care for Cancer Patients in the Prevention of Complications of Chemotherapy and Head and Neck Radiation Therapy
Oncological diseases occupy one of the first places in the structure of disability and mortality of the population. The main methods of treating patients with malignant tumors in the maxillofacial area are surgical method, radiation therapy and chemotherapy. Treatment with only one of the listed methods It is rarely performed, mainly at the stage of cancer in situ or stage I of the disease. The treatment depends on the clinical and morphological characteristics of the tumor and requires the use of all methods simultaneously or in a certain sequence. Radiation and chemotherapy treatments not only have systemic side effects, but also side effects in the treatment area. Against the background of antitumor treatment, there is an exacerbation of concomitant chronic diseases, including odontogenic ones. Pathological changes appear on the mucous membrane oral cavity, on the skin, in the subcutaneous tissue, in the salivary glands and in the bone marrow of the jaw bones. The degree of damage to these structures during tumor treatment depends on their initial condition. At the same time, the initial condition of the oral cavity affects the quality of antitumor treatment. Poor oral hygiene and chronic odontogenic lesions can cause the development of episodic fevers and other general complications. All this requires stopping or changes in the tactics of antitumor treatment, which reduces its radicalism. It becomes obvious that sanitation of the oral cavity, carried out before treatment by an oncologist, will avoid or reduce the frequency complications in the maxillofacial area, improve the quality of life of an oncology patient. Dental care for such a patient has features and requires an individual approach. The purpose of this study was to review the literature on the main oral tissue complications arising from chemotherapy and radiation therapy in the head and neck region. In Google Scholar, Medline, Scopus, Web of Sciences, PubMed a systematic review was conducted. Search keywords terms included head and neck cancer, dental care, prevention of complications of cancer, oral tissue lesions manifestationin, chemotherapy, head and neck radiation therapy. Conducted a preliminary search and reviewed 132 titles and abstracts in this literary review included 48 article. This article analyzes the main complications of oral tissues resulting from chemotherapy and radiation therapy in the head and neck area and provides practical recommendations for the management and prevention of complications in this category of patients.
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