舌癌伴后枕部巨大皮下脂肪瘤1例的围手术期护理
A Case of Nursing Care of One Patient with Tongue Cancer and Giant Subcutaneous Lipoma in Occiput

舌癌是头颈部最常见的恶性肿瘤之一，5年存活率为50%~70%，晚期舌癌患者的5年生存率更低[1]。手术根治是目前治疗舌癌的最佳手段。但舌–颌–颈联合根治手术范围大，当舌缺损超过舌体1/2时，直接拉拢缝合创面影响患者的咀嚼，吞咽，发音功能，自20世纪70年代以来，随着显微外科技术的发展，各类游离组织瓣逐步应用于口腔颌面部缺损的修复中，并成为头颈部修复重建的主流 REF _Ref390347118 \r \h [2] REF _Ref390347119 \r \h [3]，对于舌–颌–颈联合根治同期行股前外侧皮瓣或前臂皮瓣的患者，因皮瓣移植行血管吻合，术后为防止血管扭曲，要求去枕平卧位头部按一定的角度制动5~7天。2013年9月30日，本院为1例舌癌伴后枕部巨大皮下脂肪瘤患者行舌–颌–颈联合根治同期取股前外侧皮瓣修复手术，现将护理体会报告如下。

Abstract: Tongue cancer is one of the most common malignant cancers in pate. Its 5-year survival rate is only 50% to 70%, and the advanced tongue cancer is even lower. The best way to cure this disease is doing operations. However, the range of tongue-jaw-neck operation is too wide. If the tongue defect rate is over 50%, the function of chew and swallow will be affected because of the direct suture of wound. With the development of science and technology, all kinds of free flaps have been gradually applied in the repair of oral and maxillofacial region defect and have been the mainstream of repair and reconstruction of neck from 1970s. Patients who are under the treatment of tongue-jaw-neck and anterolateral thigh flap or antebrachial flap should lie down without pillow and their heads should be placed with certain position for 5 to 7 days to prevent the buckling of vessel after operation to let the flap match the transplanted vessel. On September 30th, 2013, our hospital did tongue-jaw-neck and anterolateral thigh flap operation for the patient who has tongue cancer and giant subcutaneous lipoma. The nursing care report is as follows.

[1] 胡永杰, 钟来平, 张志愿, 等 (2007) 晚期舌癌患者扩大根治术疗效分析. 中国口腔颌面外科杂志, 6, 413-417.

[2] Song, X.M., Ye, J.H., Yuan, Y., et al. (2010) Radial forearm free flap for reconstruction of a large defect after radical ablation of carcinoma of the tongue and floor of the mouth: Some new modifications. ORL: Journal for Oto-Rhino- Laryngology and Its Related Specialties, 2, 106-112.

[3] Brown, L., Rieger, J.M., Harris, J., et al. (2010) A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: Tongue mobility and swallowing function. Journal of Oral and Maxillofacial Surgery, 11, 2690-2700.

[4] 邱雷, 曾琦桥 (2012) 前臂游离皮瓣修复舌癌术后组织缺损26例临床护理. 齐鲁护理杂志, 14, 73-75.

[5] 张森林, 殷俭, 周平, 等 (2004) 胸大肌皮瓣修复口腔颌面颈部缺损的护理. 医学研究生学报, 6, 571-572.

[6] 陈冬兰, 莫福琴, 黄代娜, 等 (2013) 喉癌患者术后鼻饲量与间隔时间研究. 护理学杂志, 10, 54-56.