目的 探讨早期吞咽摄食干预对舌癌术后患者吞咽障碍及生活质量的影响.方法 选取2018年4月-2019年3月收治的50例舌癌患者为对照组,2019年4月-2020年3月收治的50例舌癌患者为观察组.对照组给予基础康复管理,观察组于术后5 d给予早期吞咽摄食干预.术后5 d、术后2周、术后1个月,采用洼田饮水试验及吞咽相关生命质量量表(SWAL-QOL)评估2组患者的吞咽功能和生活质量.结果 术后2周,观察组吞咽功能评分低于对照组,差异有统计学意义(P＜0.05);术后2周及术后1个月,观察组SWAL-QOL评分高于对照组,差异有统计学意义(P＜0.05);术后1个月内,2组不良事件发生率比较,差异有统计学意义(P＜0.05).结论 早期吞咽摄食干预可显著改善舌癌术后患者吞咽功能,减少不良事件的发生,改善患者术后生活质量.

目的:研究经口入路机器人手术(transoral robotic surgery,TORS)治疗舌根部肿物的临床技术可行性、安全性及有效性.方法:回顾性分析2018年9月～2020年10月期间解放军总医院口腔科开展的11例达芬奇机器人经口切除舌根部肿物患者的临床资料,男性8例,女性3例,中位年龄39岁.结果:11例患者术野暴露平均用时40.9min,平均手术时间为42.5min,平均出血量34.5ml,患者术后平均住院时间2.9d.11例患者均使用达芬奇机器人经口入路完全切除舌根部肿物,无中转开放病例.术后辅助放疗4例.术后切缘均为阴性,术中术后无严重并发症出现.术后随访8～33个月,无局部复发、远处转移或死亡病例.结论:在掌握好适应证的前提下,达芬奇机器人经口切除舌根部肿物是安全且有效的外科治疗方法,且该手术方式避免了面颈部手术瘢痕,美观满意度较高.

目的:总结口腔颌面外科机器人手术的应用经验.方法:解放军总医院口腔科应用达芬奇机器人手术系统对9例位于口腔深部肿瘤患者行经口入路机器人手术(transoral robotic surgery,TORS),总结手术经验与体会.结果:患者均顺利完成手术,摆位及术区暴露用时20～90 min,平均42.2 min;手术时间5～90 min,平均40.9 min.除1例双侧颈淋巴清扫术患者外,其余纯口腔入路患者8例,术后平均住院日3.25 d,术后均顺利出院,平均住院天数7.75 d.结论:达芬奇机器人手术系统可以独立完成口腔深部肿瘤手术,但在特殊患者如舌根肿瘤手术上仍有一定困难,主要是术区暴露时间较长.

Objective:The first case of transoral robotic surgery orthorax was performed in our hospital,which provided experience for the application of maxillofacial surgery robot in the future.Methods:First case of TORS was applied to a patient suffered from soft palate tumor with the Da Vinci robotic operation system in the Department of Stomatology of the General Hospital of the PLA,and the experience was summarized.Results:The operation was successfully completed.The operation area was exposed within 30 minutes,the operation time was 20 minutes,and the patient was discharged from the hospital in 2 days after the operation.Conclusion:Da Vinci robotic surgery system can independently complete the deep tumor of the mouth and has great potential for clinical application in oral and maxillofacial surgery.

Objective: To investigate the application effect of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects. Methods: This study is a prospective study, and 50 patients with mandibular tumor were enrolled in the research. And all of them were divided into observation group (25 cases) and control group (25 cases). The patients of observation group were implemented precise remodeling of mandible by using prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap, and that of control group were implemented remodeling of mandible by using virtual surgery assisted to vascularized iliac bone-muscular flap. And the occurrences of surgical effect and adverse reaction between the two groups were compared and analyzed. Results: The surgical effect of observation group (24 cases, 96%) was significantly higher than that of control group (20 cases, 80%) (x2=10.951, P<0.05). And the adverse reaction rate of observation group (5 cases, 20%) was significantly lower than that of control group (13 cases, 52%) (x2=10.624, P<0.05). Conclusion:Prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap can obtain better effect in repairing and reconstructing mandibular defects, and its postoperative adverse reactions are less.

Objective:To investigate the effect of insulin (In),estrogen (E2) and culture time on the proliferation of newborn rat mandibular osteoblasts (NRMOBs).Methods:The NRMOBs were cultured in vitro.The effect of insulin (6ug/mL) and/or estrogen (10-9 moUL) and/or culture time on NRMOBs was investigated.The NRMOBs proliferation was examined after 1、3、5、7、9 days of culture using Methylthiazol Tetrazolium (MTT).Results:The NRMOBs positively expressed vimentin and osteocalcin,negatively expressed keratin,secreted alkaline phosphatase (ALP),and produced calcium nodules.When NRMOBs were cultured in the media with 5.5mM glucose,estrogen significantly decreased the cells proliferation at 1 day of culture,insulin significantly increased the cells proliferation at 7,9 day of culture.Compared to 5.5mM+E2,5.5mM+Insulin significantly increased NRMOBs proliferation at 7,9 day of culture.The combination of insulin andestrogen had no effect on the proliferation of NRMOBs at every time point.Conclusion:This study suggests that insulin or estrogen alone affects NRMOBs proliferation in different culture time.The combination of insulin and estrogen can adjust the effect of insulin or estrogen alone on NRMOBs proliferation.

本文重点关注在应用大块组织工程骨修复大段骨缺损时,其中心的部分经常因缺血而发生坏死,所以在新生的骨组织形成之前构建血供系统是极其重要的一步。因此,"成血管化"成为组织工程骨修复骨缺损的关键。本文通过对血管生成过程,成血管细胞、因子、主要的成血管化方法,以及成血管化对成骨的作用介绍,阐述了成血管化是组织工程骨成骨的重要前提。