口腔癌切除合併頸部淋巴廓清術後的物理治療個案報告

Oral Cancer under Surgery with Functional Neck Dissection and Physical Therapy Intervention: A Case Report

蘇翠玲(Tsui-Ling Su) ； 杜婉瑜(Wan-Yu Du)

《物理治療》 40卷2期 (2015/06) Pp. 66-71

https://doi.org/10.6215/FJPT.PTS1419479011

摘要

發生在口腔部位之惡性腫瘤統稱為口腔癌，排行我國男性腫瘤的第四位。其好發於長期抽菸、喝酒及嚼食檳榔的族群，與生活型態息息相關。外科手術是目前治療最基本有效的選擇，但對組織會產生一定的破壞及後續生活品質與功能的降低。其影響包括：牙關緊閉、肩頸疼痛、肩關節活動度受限及上肢肌力與心肺功能的降低。本報告之個案為一位56歲男性，有抽菸、喝酒與嚼食檳榔習慣長達35年。由於右臉頰的疼痛且體重減輕而到醫院就診，經診斷確定為右頰鱗狀細胞癌（Right buccal cancer），癌症分級T2N0M0（第II期）。個案在接受右頰之腫瘤切除及功能性頸部淋巴廓清術（Functional neck dissection）後感到張口困難以及肩部活動疼痛轉而轉介物理治療。物理治療理學檢查，發現個案患側肩關節有主動活動度不足、肌肉無力、牙關緊閉與運動耐受度不足的情況，進而影響其生活品質。以往物理治療對於相關個案多著重在張口幅度及疼痛的處理，本案加入核心肌群及心肺訓練；經由12週的物理治療介入，個案的活動度與肌力有大幅改善，六分鐘行走測試和生活品質問卷皆有臨床顯著增加。

關鍵字

口腔癌 ； 物理治療 ； 頸部淋巴廓清術

並列摘要

Oral cancer, malignant neoplasm of the oral cavity, is ranked as the fourth most common cancer in Taiwanese male population. It is commonly found in patients with long-term smoking, drinking, and betel nut chewing habits. Primary treatment for oral cancer is surgery, in which cancerous tissues are dissected, thus preventing them from spreading to other parts of the body. After surgery, patients may experience postoperative complications such as trismus, shoulder and neck pain, shoulder range of motion(ROM) limitation and decrease in upper extremity strength and cardiopulmonary fitness, leading to a decreased quality of life and body function. This is an evidence-based case report of a 56-year-old male patient who had a history of smoking, drinking, and betel nut chewing for ＞35 years. Having wound pain in his right cheek and substantial weight loss, the patient sought medical advice and was diagnosed as right buccal cancer (T2N0M0). After the surgery of right functional neck dissection for removal of the tumor, the patient was referred to physical therapy treatment for difficulty in mouth opening and shoulder pain during movement. During physical examination, ROM limitation in the right shoulder, muscle weakness, trismus, lack of exercise endurance, and decreased quality of life were noted. Different from traditional physical therapy which focused more on the range of mouth opening and pain relieving, core muscle and cardiopulmonary exercise were added to the case. After 12 weeks of intervention, improvement was observed in the right shoulder ROM, muscle strength, Six-Minute Walk Test, and quality of life.

並列關鍵字

Oral cancer ； Physical therapy ； Functional neck dissection