新型冠状病毒肺炎疫情形势下肿瘤专科医院头颈部恶性肿瘤诊治体会:附38例报告
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韩春, Email: hanchun@zjcc.org.cn

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浙江省公益技术应用研究基金资助项目(2017C33180)。


Treatment strategies for head and neck tumors in cancer-specialized hospital amid the novel coronavirus (COVID-19) pandemic: a report of 38 cases
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    摘要:

    背景与目的:2019年12月开始出现的新型冠状病毒肺炎(COVID-19)正在全球呈流行态势。有研究发现,肿瘤患者罹患COVID-19的风险较高,且更易出现重症及病情恶化。头颈肿瘤作为肿瘤专科医院接诊的重要病种,病例基数庞大,疾病复杂,部分肿瘤恶性程度极高,往往进展迅速,经不起拖延,而开展头颈肿瘤诊疗活动需要进行口腔、喉及气道等部位的操作本身又可能增加COVID-19医患感染风险。因此,本研究着重探讨COVID-19疫情形势下肿瘤专科医院头颈肿瘤的诊治和防控策略。
    方法:回顾性分析2020年2月1日—2020年2月22日 在中国科学院大学附属肿瘤医院(浙江省肿瘤医院)头颈外科预约收治的38例头颈部恶性肿瘤患者的临床资料。本中心实行分时段预约就诊,基于诊疗指南和临床实践合理分流患者,严格把握住院指征。所有收住患者均需进行详细的流行病学调查、核酸检测和胸部CT扫描,排除COVID-19后方能接受手术或化疗。诊疗期间严格执行疫情防控措施,仔细观察诊疗经过,关注体温监测和管理,出院后跟踪随访患者恢复情况并通过互联网医院或其他网络途径实施医学指导和后续治疗。
    结果:头颈部恶性肿瘤38例患者中,男17例,女21例,平均49岁;其中甲状腺癌21例,口腔恶性肿瘤6例,唾液腺癌3例,喉癌2例,下咽癌2例,颈段食管癌1例,淋巴瘤1例,鼻咽癌1例,血管肉瘤1例。31例接受手术治疗,7例接受化疗,诊疗过程中3例出现发热,其中1例为粒缺性发热,1例为肿瘤坏死感染发热,1例因切口感染而发热,患者总体经过顺利,恢复良好,住院期间及出院后随访2周未发现患者和医务人员COVID-19感染。
    结论:COVID-19疫情形势下,基于诊疗指南和临床实践,合理分流、科学防控,充分利用“互联网+医疗”的优势,在积极投身抗击疫情同时,保护肿瘤患者免受病毒感染,并做好患者的心理支持,将疫情对治疗的影响降到最低并保证治疗的延续性是头颈肿瘤临床诊疗工作的可行策略。

    Abstract:

    Background and Aims: The novel coronavirus (COVID-19), discovered in December 2019, has now spread throughout the world. Studies have shown that patients with cancer have a higher risk of COVID-19 and are more likely to develop severe symptoms and progress to exacerbation. Head and neck tumors, as the major disease entities to be encountered in a cancer-specialized hospital, have a large number of cases of complex disorders, and some of them are highly malignant with rapid progress, for which the treatment cannot be delayed. Moreover, the operations involving the mouth, throat and airway are unavoidable during the diagnosis and treatment process of head and neck tumors, which may increase the risk of COVID-19 infection between doctors and patients. Therefore, this study was conducted to mainly investigate the appropriate diagnosis and treatment of head and neck tumors and prevention and control strategies of COVID-19 in a cancer-specialized hospital amid the COVID-19 pandemic.  
    Methods: The clinical data of 38 patients with head and neck malignant tumors admitted for therapy by scheduled appointment in Zhejiang Cancer Hospital from February 1th, 2020 to February 22rd, 2020 were retrospectively analyzed. In our center, the time-phased appointments were implemented, patients were appropriately diverted based on the diagnosis and treatment guidelines and clinical practice, and the hospitalization indications were rigorously adhered to. All admitted patients received surgery or chemotherapy on the premise of exclusion of COVID-19 by detailed epidemiological investigation, nucleic acid detection and chest CT scan. During hospitalization, the epidemic prevention and control measures were strictly implemented, the treatment process was carefully observed, and the temperature monitoring and management were paid particular attention. After discharge, the outcomes of patients were followed up and the patients received medical advice and post-discharge treatment through internet-based hospitals or other online channels. 
    Results: Among the 38 patients with head and neck tumors, 17 cases were males and 21 were females, with an average age of 49 years. There were 21 cases of thyroid cancer, 6 cases of oral malignancies, 3 cases of salivary gland cancer, 2 cases of laryngeal cancer, 2 cases of hypopharyngeal cancer, and 1 case each of cervical esophageal cancer, lymphoma, nasopharyngeal cancer and of angiosarcoma. COVID-19 was excluded in all 38 patients upon admission. Thirty-one patients underwent surgical treatment and the other 7 patients were subjected to chemotherapy. Fever occurred in 3 patients during the process of treatment, which included fever associated with agranulocytosis in 1 case, fever caused by tumor necrosis and infection in 1 case and fever caused by wound infection in 1 case. Patients generally had an uneventful treatment course and recovered well. No COVID-19 infection was found in patients and medical staff during hospitalization and at the end of 2 weeks after discharge from hospital.
    Conclusion: In the situation of COVID-19 pandemic, rational distribution of patients as well as scientific prevention and control based on the diagnosis and treatment guidelines and clinical practice, making full use of the advantages of "internet + medical service", to protect cancer patients from virus while engage in the fight against the epidemic, providing psychological support to the patients, and minimizing the impact of the epidemic on treatment and ensuring the continuity of treatment are feasible strategies for the clinical treatment of head and neck tumors.

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丁金旺, 莫康楠, 李方印, 楼建林, 王兰, 韩春, 叶柳青, 赵佳正, 王可敬,.新型冠状病毒肺炎疫情形势下肿瘤专科医院头颈部恶性肿瘤诊治体会:附38例报告[J].中国普通外科杂志,2020,29(5):589-595.
DOI:10.7659/j. issn.1005-6947.2020.05.010

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  • 收稿日期:2019-03-20
  • 最后修改日期:2019-03-20
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  • 在线发布日期: 2020-05-25