Journal Article 精神発達遅滞を有する進行口腔がん患者への外科治療経験

日笠, 紘志  ,  榊原, 典幸  ,  水野, 貴行  ,  加藤, 卓己  ,  箕輪, 和行  ,  高野, 昌士

36 ( 1 )  , pp.14 - 20 , 2015-09 , 北海道歯学会
精神発達遅滞を有する口腔がん患者は,その精神疾患の特異性より,説明と同意,周術期管理,術後リハビリ,退院時支援に困難さを有し,放射線療法や化学療法を主体とする保存的治療を選択することが多く,外科治療を行った報告は少ない.我々は精神発達遅滞を有する進行口腔癌患者に対して外科治療を主体とした根治治療を行い,良好な経過を得たのでその概要を報告する.  患者は46歳女性,近医歯科にて右側軟口蓋の腫脹を指摘され当科受診.既往歴に精神発達遅滞を認め,精神年齢は9歳相当であった.また生活背景として家族全員が精神発達遅滞を有していた.口腔内所見は右側軟口蓋を中心に硬口蓋,左側軟口蓋,咽頭におよぶ弾性やや硬の腫瘤を形成.画像所見上で悪性腫瘍を疑う所見が得られたため組織生検を施行し粘表皮癌の病理診断を得た.生活支援センター職員援助のもと,ご本人,ご家族との話し合いを重ね,外科的に根治治療を行う方針とし,全身麻酔下にて右側肩甲舌骨筋上頸部郭清術,腫瘍切除術(右側上顎全摘術,左側上顎部分切除術)および遊離腹直筋皮弁による口腔再建術を施行した.  術後2年7ヶ月を経過し局所再発・遠隔転移を認めず現在経過観察中である.
Oral cancer patients with mental retardation have specific needs due to their mental condition. Conservative treatment consisting mainly of radiation therapy is often selected because of difficulties in explaining and obtaining consent, perioperative management, postoperative rehabilitation, and support upon discharge. For these reasons there are few reports on surgical treatment. Reported here is an outline of treatment in which favorable results were obtained when surgical treatment was performed on an advanced oral cancer patient with mental retardation. The patient was a 46-year-old female who was referred to our department when swelling in the right soft palate was discovered at a nearby dental clinic. Medical history showed mental retardation with a mental age equivalent of a 9-year-old child. Background information showed the entire family had mental retardation. Intraoral findings indicated the formation of an elastic slightly hard mass centered in the right soft palate and extending to the hard palate, left soft palate, and pharynx. Because imaging findings were suspicious for malignancy a biopsy was performed and a pathological diagnosis of mucoepidermoid carcinoma was obtained. After repeated discussions with the patient and her family, with the aid of the Livelihood Support Center staff, a surgical curative treatment was chosen. Right total neck dissection and tumor resection (right subtotal maxillectomy) with oral reconstruction by rectus abdominis muscle flap was performed under general anesthesia. The patient is currently under observation at 2 years and 3 months after surgery and there are no signs of local recurrence or distant metastasis of the malignancy.

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