口腔颌面肿瘤总论（二）课件_1

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1、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combinedandsequentialtherapy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、

2、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(Radiationtherapy)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(conservativefunctionalsurgery)修复性功能性外科(reconstructivefu

3、nctionalsurgery)防止医源播散无瘤原则切缘在正常组织内整块切除（enbloc）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TongueReconstructionMandibleReconstructionRadiationTherapyProf.Rontgen–XrayProf.MarieCurie–RadiumelementDefinition–ionizingradiationComponentofmulti-modalitytherapyIncreasinguseforheadandneckcancerPrincipleRadiationsensit

4、iveTypesofradiationtherapyExternalbeam(外照射)vs.Brachytherapy(腔内照射)CommoncomplicationsGeneralPrincipleBasis–ionizing(电离)particlesinteractwithcellularmoleculesDamagesDNAimpossibleforthecellstogrowDamagesbothcancerandnormalcells,thelatterareabletorepairthemselvesUsedto:CombinedorassinglemodalityTrea

5、tlocalizedtumorsTreatleukemiaandlymphomaRapidlydividingcellpopulationsarethemostsensitivetoradiationtumors,epithelialcells,hemopoieticcells(造血细胞)RadiobiologyExternalbeamElectronlinearaccelerator直线加速器Gammarays(Co60)TopatientShieldedcontainerRadioactivesourcesFlexiblehoseCatheterRadioactivewireRad

6、ium“needles”AfterloadingBrachytherapyInternalradiotherapyTreatmentplansystemComplicationsAcuteTissueReactionsLateTissueReactionsAcuteToxicityMucosalreactions–2ndweekofXRTMucositisSkinreactions–5thweekGenerallysubsideseveralweeksaftercompletionoftreatmentLateToxicityInjurytendstobepermanentDevelo

7、pwithinmonthstoyearsXerostomia(口干症),radionecrosisofbone,dentalcaries,fibrosis,soft-tissuenecrosis,nervetissuedamageChemotherapyOneofthemaintechnologiesagainstcancerDefinitionNotcurative,usedonlyasanadjunctFirstappliedin1946U