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李一 四川大学华西口腔医学院教授，硕士生导师。现任中国抗癌协会头颈肿瘤专业委员会青年委员，中华口腔医学会口腔急诊专业委员会委员，四川省口腔医学会口腔颌面外科专业委员会常务委员，四川省口腔医学会青年委员，国际口腔颌面外科医师协会会员。承担课程：口腔颌面外科学。主要研究方向为头颈肿瘤防治及修复重建。负责和主研国家自然科学基金项目1 项；负责和主研四川省科技厅应用基础项目1 项。现以第一作者或通讯作者发表SCI 论文10 余篇，参编包括《中华口腔医学大词典》《华西口腔住院医师手册》等多部专著，多次参加国内外学术会议并进行大会发言。
目录
- 目 录
第一章 口腔颌面部肿瘤的分类和发病原因 ············································ 1
1. 什么是口腔颌面部肿瘤 ····························································· 1
2. 什么是囊肿 ············································································ 2
3. 什么是良性肿瘤 ······································································ 3
4. 什么是恶性肿瘤 ······································································ 4
5. 什么是恶性肿瘤的淋巴转移 ······················································· 5
6. 什么是恶性肿瘤的血行转移 ······················································· 5
7. 血管瘤是不是肿瘤 ··································································· 6
8. 癌与肿瘤是什么关系 ································································ 6
9. 什么是癌前病损和癌前状态 ······················································· 7
10. 囊肿与肿瘤的区别是什么 ························································· 7
11. 良性肿瘤与恶性肿瘤的区别是什么 ············································· 8
12. 囊肿会不会恶变 ····································································· 8
13. 良性肿瘤会不会恶变 ······························································· 9
14. 口腔颌面部哪些部位容易长肿瘤 ················································ 9
15. 口腔颌面部常见的囊肿有哪些 ················································· 10
16. 口腔颌面部常见的良性肿瘤有哪些 ··········································· 10
17. 口腔颌面部常见的癌前病损有哪些 ··········································· 11
18. 口腔颌面部常见的恶性肿瘤有哪些 ··········································· 11
19. 囊肿是怎么形成的 ································································ 12
20. 肿瘤是怎么形成的 ································································ 12
21. 为什么说肿瘤是基因病 ·························································· 13
22. 肿瘤会传染吗 ······································································ 13
23. 肿瘤会遗传吗 ······································································ 14
24. 肿瘤发生与人体免疫力有什么关系 ··········································· 14
25. 肿瘤发生与年龄有没有关系 ···················································· 15
26. 肿瘤发生与性别有没有关系 ···················································· 15
27. 病毒感染与口腔颌面部肿瘤发生有关系吗 ·································· 16
28. 吸烟容易得口腔癌吗 ····························································· 16
29. 喝酒容易得口腔癌吗 ····························································· 17
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30. 嚼槟榔容易得口腔癌吗 ·························································· 17
31. 促使口腔颌面部肿瘤发生的危险因素有哪些 ······························· 17
32. 有哪些不良习惯可能促使口腔颌面部肿瘤发生 ···························· 18
33. 口腔科检查用的X 线（牙片、CBCT）致癌吗 ····························· 19
34. 如何预防口腔颌面部肿瘤的发生 ·············································· 19
第二章 口腔颌面部肿瘤的检查方法 ··················································· 20
1. 常用的检查分为哪几类 ···························································· 20
2. 抽血化验有哪些检查内容 ························································· 20
3. 抽血化验前为什么要空腹 ························································· 21
4. 什么是活组织检查 ·································································· 21
5. 所有肿瘤都可以做活检吗 ························································· 22
6. 什么是术中活检（快速冷冻活检） ············································· 22
7. 什么是术后病理检查 ······························································· 23
8. 为什么术中活检与术后病理检查结果可能不一致，不一致时
以什么为准 ··········································································· 23
9. 免疫组织化学技术是什么 ························································· 24
10. 口腔颌面部肿瘤诊断有没有“金标准”，“金标准”是什么 ············· 24
11. 常用的影像学检查有哪些 ······················································· 24
12. 什么是口腔全景片 ································································ 25
13. 什么是CT ··········································································· 25
14. 什么是增强CT，一般什么情况下要做增强CT ···························· 25
15. 什么是CBCT ······································································· 26
16. 什么是MRI ········································································· 26
17. 什么是PET/CT ····································································· 27
18. 什么是DSA ········································································· 28
19. 什么是涎腺内镜检查 ····························································· 28
20. 手术前一般需要做哪些常规检查 ·············································· 28
21. 为什么手术前要拍胸片 ·························································· 29
22. 为什么手术前要做心电图检查 ················································· 29
23. 手术后为什么要定期复查 ······················································· 30
24. 如何自我检查早期发现颌面部肿瘤 ··········································· 30
25. 孕妇有哪些检查项目不宜做 ···················································· 31
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第三章 口腔颌面部肿瘤的治疗 ························································· 32
1. 良性肿瘤生长慢，是不是可以不用治疗 ······································ 32
2. 良性肿瘤是不是切除术后就不会复发 ········································· 32
3. 我的口腔颌面部疑似有肿瘤，什么情况下要立刻到医院就诊
咨询医生，有哪些肿瘤可以先观察一下 ······································ 33
4. 是不是只要多切一些，就能保证我的肿瘤能根治 ·························· 33
5. 颌面部血管瘤怎么治疗 ··························································· 33
6. 牙龈瘤为什么要拔除累及牙齿甚至要切除颌骨 ····························· 34
7. 颌面部色素痣切除原则是什么 ·················································· 34
8. 甲状舌管囊肿为什么需要切除舌骨 ············································ 34
9. 鳃裂囊肿为什么容易复发 ························································ 34
10. 颌下腺肿瘤手术方式及并发症是什么 ········································ 35
11. 舌下腺肿瘤手术方式及并发症是什么 ········································ 35
12. 腭部包块手术方式及并发症是什么 ··········································· 36
13. 腮腺包块手术方式及并发症是什么 ··········································· 36
14. 有的腮腺手术患者术后为什么会出现面瘫症状 ···························· 37
15. 为什么腮腺手术要放组织补片 ················································· 37
16. 腮腺肿瘤患者什么情况下需要切断面神经 ·································· 37
17. 腮腺手术这么可怕，能不能只摘除包块即可 ······························· 38
18. 腮腺区穿刺活检可靠吗 ·························································· 38
19. 为什么头颈部有些肿瘤的诊断不能做活检 ·································· 38
20. 为什么肿瘤看上去不大，手术切除范围这么大 ···························· 39
21. 口腔颌面部癌前病变是什么，都有什么特征 ······························· 39
22. 口腔颌面部癌前病变会不会都会恶变 ········································ 40
23. 癌前病变不是癌症，是否也要手术切除才能根治 ························· 40
24. 头颈部恶性肿瘤容易复发吗 ···················································· 40
25. 如何避免头颈部恶性肿瘤复发 ················································· 40
26. 头颈部肿瘤综合治疗的原则是什么 ··········································· 41
27. 头颈部恶性肿瘤单纯手术能治愈吗 ··········································· 41
28. 哪些口腔颌面部肿瘤患者不需要进行外科手术治疗 ······················ 42
29. 口腔颌面部肿瘤患者外科手术治疗后有哪些功能受影响 ··············· 42
30. 口腔癌患者为什么需要治疗颈部 ·············································· 42
31. 什么是联合根治术 ································································ 43
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32. 联合根治术有哪些并发症 ······················································· 43
33. 切除口腔颌面部软组织肿瘤后常用的缺损修复方法有什么 ············· 44
34. 口腔手术为什么要在全身取皮瓣组织 ········································ 44
35. 皮瓣手术通常选用的取皮瓣区有哪些 ········································ 44
36. 皮瓣移植失败了怎么办 ·························································· 44
37. 做了皮瓣手术后还能做放疗吗 ················································· 45
38. 为什么有些颌骨囊肿手术相关牙齿术前需要做根管治疗 ················ 45
39. 哪些颌骨肿瘤可以保留颌骨 ···················································· 45
40. 为什么有些良性肿瘤也要切除颌骨 ··········································· 46
41. 颌面部肿瘤术后骨缺损有哪些修复方式 ····································· 46
42. 游离植骨术后并发症有哪些 ···················································· 46
43. 颌面部肿瘤术后的重建板、小夹板需要取出吗 ···························· 47
44. 口腔颌面部肿瘤患者有哪些治疗方法 ········································ 47
45. 口腔颌面部肿瘤可以自愈吗 ···················································· 47
46. 口腔颌面部肿瘤可以治愈吗 ···················································· 48
47. 口腔颌面部肿瘤治疗的基本原则是什么 ····································· 48
48. 口腔颌面部肿瘤治疗的关键是什么 ··········································· 48
49. 常用口腔颌面部肿瘤治疗手段都有哪些不足之处 ························· 49
50. 放化疗对头颈部恶性肿瘤患者身体损伤很大吗 ···························· 49
51. 口腔颌面部肿瘤患者的化疗治疗方案制订原则是什么 ··················· 49
52. 化疗的全身副作用主要有什么 ················································· 49
53. 口腔颌面部肿瘤患者的放疗治疗方案制订原则是什么 ··················· 50
54. 放疗的全身副作用主要有什么 ················································· 50
55. 放射性骨髓炎是什么 ····························································· 51
56. 放疗前需要做哪些准备 ·························································· 52
57. 基因治疗是什么 ··································································· 52
58. 质子治疗头颈部肿瘤效果如何 ················································· 52
59. 中医、中药对头颈部恶性肿瘤有效吗 ········································ 52
60. 口腔颌面部肿瘤患者治疗的心理健康重要吗 ······························· 53
61. 口腔颌面部肿瘤对面部美观有哪些影响 ····································· 53
62. 有哪些办法可以减少手术对美观、功能的影响 ···························· 53
63. 什么是临床痊愈 ··································································· 54
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第四章 口腔颌面部肿瘤的预防方法和治疗效果 ···································· 55
1. 什么叫做肿瘤的预防 ······························································ 55
2. 什么叫做肿瘤的三级预防原则 ·················································· 56
3. 如何做到口腔颌面部恶性肿瘤的一级预防 ··································· 56
4. 如何做到口腔颌面部恶性肿瘤的二级预防 ··································· 57
5. 如何做到口腔颌面部恶性肿瘤的三级预防 ··································· 58
6. 预防口腔癌的人乳头瘤病毒疫苗有效吗 ······································ 58
7. 口腔颌面部良性肿瘤、囊肿需要预防吗 ······································ 59
8. 口腔颌面部良性肿瘤、囊肿如何预防 ········································· 59
9. 有哪些良性肿瘤、囊肿需要预防复发、恶变 ································ 60
10. 什么叫做肿瘤的预后 ····························································· 60
11. 什么叫做恶性肿瘤的3 年生存率、5 年生存率 ···························· 61
12. 口腔癌的预后如何 ································································ 61
13. 唾液腺癌的预后如何 ····························································· 62
14. 颌骨恶性肿瘤的预后如何 ······················································· 62
15. 良性肿瘤需要关注预后吗 ······················································· 63
16. 哪些良性肿瘤容易复发 ·························································· 63
17. 哪些良性肿瘤容易恶变 ·························································· 64
第五章 口腔颌面部肿瘤患者的护理和康复 ·········································· 65
1. 口腔颌面肿瘤患者术前疼痛应怎样护理 ······································ 65
2. 口腔恶性肿瘤患者术前应怎样做好口腔护理，避免出血 ················· 65
3. 口腔肿瘤患者为什么术前要保持口腔卫生 ··································· 66
4. 口腔肿瘤患者为什么术前要戒烟戒酒 ········································· 66
5. 口腔肿瘤患者术前饮食要注意什么 ············································ 67
6. 口腔肿瘤合并糖尿病患者术前饮食有什么讲究 ····························· 68
7. 口腔肿瘤合并高血压患者术前饮食应该如何调理 ·························· 68
8. 口腔恶性肿瘤患者围手术期如何进行心理干预 ····························· 69
9. 口腔颌面肿瘤患者为什么术前要进行呼吸功能训练 ······················· 69
10. 口腔颌面肿瘤患者全麻术前多久开始禁饮食，全麻术后多久
可以进食 ············································································ 70
11. 口腔颌面肿瘤患者术后出现痰液过多怎么办 ······························· 70
12. 口腔颌面肿瘤患者术后出现痰中带血丝怎么办 ···························· 70
13. 口腔皮瓣移植患者术后皮瓣怎么护理 ········································ 71
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14. 口腔皮瓣移植患者术后为什么不能说话 ····································· 72
15. 口腔植骨患者术后出现面部肿胀怎么办 ····································· 72
16. 移植髂骨的患者为什么要用盐袋压迫取髂骨处 ···························· 73
17. 口腔植骨患者术后什么时候能下床活动 ····································· 73
18. 口腔植骨患者出院后能正常活动吗 ··········································· 73
19. 口腔肿瘤患者术后出现咽喉部疼痛应怎样护理 ···························· 73
20. 口腔肿瘤患者术后功能恢复过程中如何避免伤口开裂 ··················· 73
21. 口腔恶性肿瘤患者皮瓣移植术后为什么要保持头部制动 ················ 74
22. 舌癌患者术后怎样和医护人员有效沟通 ····································· 74
23. 口腔恶性肿瘤患者术后长期卧床如何避免褥疮的发生 ··················· 74
24. 口腔恶性肿瘤患者气管切开术后的注意事项是什么 ······················ 75
25. 口腔恶性肿瘤患者术后安置胃管后饮食注意事项是什么 ················ 75
26. 口腔肿瘤术后患者食欲下降，营养供给不足怎么办 ······················ 76
27. 口腔肿瘤术后患者留置负压引流管应注意什么 ···························· 76
28. 口腔癌术后患者进食的方法和注意的事项有哪些 ························· 77
29. 口腔肿瘤患者术后能不能热敷消肿 ··········································· 78
30. 口腔肿瘤患者术后何时进行张口训练 ········································ 78
31. 舌癌患者术后怎样进行语音功能锻炼 ········································ 78
32. 颈淋巴清扫患者术后怎样进行肩颈功能锻炼 ······························· 78
33. 腮腺多形性腺瘤患者术后为什么要观察鼓腮、闭眼、皱额 ············· 79
34. 腮腺多形性腺瘤患者为什么术后伤口要进行绷带加压包扎 ············· 79
35. 腮腺多形性腺瘤患者为什么术后要禁辛辣刺激及酸性的饮食 ·········· 79
36. 腮腺多形性腺瘤患者术后出现眼睑闭合不全应该怎么办 ················ 80
37. 腮腺多形性腺瘤患者术后若出现口角歪斜、鼓腮漏气等应怎么办 ···· 80
38. 腮腺多形性腺瘤患者出院后注意事项是什么 ······························· 80
39. 口腔恶性肿瘤患者出院后注意事项是什么 ·································· 80
40. 口腔恶性肿瘤患者化疗应怎样护理 ··········································· 80
41. 口腔肿瘤患者出院后要注意什么 ·············································· 82
附录 全国知名口腔颌面部肿瘤医院及专科介绍 ···································· 83
北京市 ····················································································· 83
辽宁省 ····················································································· 87
上海市 ····················································································· 88
湖北省 ····················································································· 89
目录
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湖南省 ···················································································· 91
广东省 ···················································································· 92
四川省 ···················································································· 93
陕西省 ···················································································· 95
专家评论
- 口腔颌面部肿瘤在全身肿瘤中是一个非常独特的种类。从发病部位来看，它包括口腔黏膜、颌面骨、唾液腺、口咽部、颈部软组织、
颅底颞下区等关键解剖区域；从疾病类型来看，它主要包括良性肿瘤、恶性肿瘤、类肿瘤性疾病等。由于口腔颌面部解剖结构和功能的特殊性，手术切除的范围非常有限，术后的器官缺损往往造成严重的颜面外形损毁和进食、语音等功能障碍，给患者及其家属造成严重的心理损害。因此，对于此类疾病的治疗，我们必须高度重视。根据既往的临床研究，口腔颌面部恶性肿瘤的治疗效果不尽如人意，早期肿瘤的五年生存率可达80%左右，而晚期患者的生存率只有不到50%，因此，早发现、早治疗仍是头颈肿瘤治疗的最有效手段。同时，结合放疗、化疗、基因和生物治疗等多学科的综合治疗策略，也是肿瘤治疗的发展方向和希望所在。
口腔颌面部肿瘤的治疗纷繁芜杂，最新科技的发展也往往带来治疗的全新变化。但是，伴随信息时代的爆炸式发展，患者和家属更容
易从网络获取庞大的信息，在这些良莠不齐的信息中，如何找到适合的内容，以利于医患之间的沟通，这是一个急需解决的问题。作为临床医生，我们往往会遇到患者提问：“网络上查到的内容并不是这样说的啊？”更有甚者，患者及家属被不良信息所诱导，去一些无良的医疗单位进行无效治疗，最终错失最佳治疗机会，不禁让我们唏嘘不已，却已无力回天。
因此，如何在患者及家属求医、治疗和术后康复的全过程给予专业、科学的指导，使他们能在庞大的信息群中去芜存菁，更有效地
与医生交流，以使患者获得最佳的治疗效果，也是目前我们最为关注的问题。在本书中，我们尝试从专业医护人员的角度出发，以一问一答的形式，用通俗易懂的语言阐述口腔颌面部肿瘤检查、诊断、治疗、预后和护理过程中可能遇到的问题，在保证专业性的同时，让患者和家属能更好地理解相关艰涩的专业问题，并获取准确的答案，同口腔颌面部肿瘤就医指南
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时，在全书的后半部分，我们精选了全国各省、市、自治区最为专业的医疗机构，以求能尽量帮助患者找到合适的医疗机构进行治疗。肿瘤医学内容异常庞大、复杂，在编写本书的过程中，难免出现一些不准确的地方，也请各位读者和专家在审阅的过程中提出宝贵意见，以帮助我们不断地完善这本科普书。
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