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目的:观察和研究常规剂量下多西他赛联合顺铂和氟尿嘧啶(TPF方案)在口腔黏膜鳞状细胞癌的诱导化疗后出现的达到Ⅳ度骨髓抑制的临床特征和治疗策略。方法:2006—2012年间接受TPF方案治疗口腔黏膜鳞癌147例,均为首治病例。对其中出现Ⅳ度骨髓抑制的29例进行回顾分析,就骨髓抑制的规律和治疗策略,白细胞和中性粒细胞的波动规律和粒细胞集落刺激因子(CSF)的疗效进行分析。结果:29例出现骨髓抑制的时间为化疗后9~14 d,中位时间10 d,平均时间10.5 d;波动的规律呈“U”形,低谷持续时间3~5 d。26例经CSF治疗后,平稳过渡到正常或下限水平,并如期行联合根治手术,创口未出现延迟愈合;2例因升白细胞治疗不理想而被要求改用“小剂量适形调强放疗”:1例因升白细胞治疗无效而并发多脏器衰竭死亡。化疗死亡率0.68%。结论:Ⅳ度骨髓抑制的发生率虽然不高但有致死性危险。本研究揭示了“U”形波动发生的起始时间和同期采用升白细胞治疗的必要性,启动骨髓抑制的应急预案,即单人消毒病房,以漱口液交替含漱;应用CSF类药物应达到正常水平上限的倍数。
OBJECTIVE: To observe and study the clinical features and therapeutic strategies of IV osteomyelitis in patients with oral mucosal squamous cell carcinoma after induction chemotherapy with docetaxel plus cisplatin and fluorouracil (TPF) under conventional dosage. Methods: 147 cases of oral squamous cell carcinoma received TPF regimen between 2006 and 2012 were the first cases. Nineteen patients with grade Ⅳ myelosuppression were retrospectively analyzed. The rules of myelosuppression and treatment strategies, the fluctuation of leukocytes and neutrophils and the efficacy of granulocyte colony stimulating factor (CSF) were analyzed. Results: The time of bone marrow suppression in 29 patients was 9-14 days after chemotherapy. The median time was 10 days and the average time was 10.5 days. The regularity of fluctuation was “U” shape and the trough duration was 3-5 days. 26 cases of CSF after treatment, a smooth transition to the normal or lower levels, and the line combined with radical operation, the wound did not appear delayed healing; 2 cases due to the ideal of leukocyte therapy was required to switch to “small dose of intensity modulated radiation therapy ”: 1 case died of multiple organ failure due to invalidation of leukocyte therapy. Chemotherapy mortality rate 0.68%. Conclusion: The incidence of grade Ⅳ myelosuppression is not high but fatal. This study revealed the onset of “U” -shaped fluctuations and the need for the use of leukocytes during the same period, initiating an emergency plan for myelosuppression, a single-patient sterilizing ward, alternately gargling with a mouthwash; The drug should reach a multiple of the normal upper limit.