血液透析患者における下顎骨半側切除術の経験

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Operations for malignant tumors in the oral cavities of patients being maintained by hemodialysis are extremely rare. We have been treating a hemodialysis patient for squamous cell carcinoma of the left mandible and a hemimandibulectomy was performed. The patient is a 60 years old male undergoing hemodialysis three times a week because of chronic renal failure. On the day before the operation, to correct the anemia and the uremia, a blood transfusion and hemodialysis were carried out. The hemimandibulectomy was performed under general inhalation anesthesia (GOF). The median incision from the center of the lower lip to the mental region was performed. Then submandibular incision from the mental region to the left mandible angle was performed, and the tumor excision with hemimandibulectomy was carried out. The reconstruction of mandible was not done. The patient was cared for in I.C.U. for 42 hours after the operation. On the second day after the operation, hemodialysis was begun. The first hemodialysis after the operation was done with local use of regional heparin. But the hemodialysis was stopped after 4 hours because of swelling in the left face and neck region. After stopping hemodialysis, swelling was reduced slowly. From the next time, the hemodialysis was done using gabexate mesilate (FOY). After 4 treatments of FOY hemodialysis, we returned to normal heparin hemodialysis. Antibiotics (LMOX. 1 g/day) were injected to prevent wound infection. Removal of the stitches was started on the 10th day after the operation and was finished on the 16th day. The reason for this delay was the slow healing of the incision caused by wound healing delay. The observation period during 2 years following the operation, reveals no signs of recurrence or metastasis.
社団法人日本口腔外科学会の論文

血液透析患者における下顎骨半側切除術の経験

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