Πρόληψη και Θεραπεία Στοματικών Λοιμώξεων σε Καρκινοπαθείς.
Χατζηπέτρου Λ.1, Αντωνιάδης Κ.2, Αντωνιάδης Β.3
Τμήμα Στοματικής και Γναθοπροσωπικής Χειρουργικής, Πανεπιστημιακή Κλινική ΑΠΘ, Γ.Π.Ν. «Γ. Παπανικολάου»
(Διευθυντής: Καθ. Δ. Θ. Καρακάσης)
1. Ειδικευόμενη Γναθοχειρουρνός.
2. Αν. Καθ. Γναθοχειρουργικής.
3. Γναθοχειρουργός
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 4(2): 87 - 97, 2003.
ΠΕΡΙΛΗΨΗ
Σκοπός της εργασίας είναι να τονιστεί πως η στοματική κοιλότητα αποτελεί συχνά περιοχή εκδήλωσης
των ανεπιθύμητων ενεργειών της αντικαρκινικής θεραπείας και καθώς οι καρκινοπαθείς έχουν μειονεκτικό
ανοσολογικό σύστημα οι ενδοστοματικές ή συστηματικές λοιμώξεις (μυκητιασικές, ιογενείς, βακτηρι-
διακές) αποτελούν σημαντικές αιτίες θνησιμότητας και νοσηρότητας.
Η επιτυχής πρόληψη και θεραπεία της στοματίτιδας και των συστηματικών λοιμώξεων βασίζονται στη
διατήρηση σταθερότητας στο μικροβιακό φορτίο της στοματικής κοιλότητας του καρκινοπαθούς, στην ακεραιότητα
της πρώτης γραμμής άμυνας του και στην ελάττωση του βαθμού της ανοσοκαταστολής. Στα πλαίσια
της πρόληψης ή της ελαχιστοποίησης των στοματικών λοιμώξεων σε κακρινοπαθείς και ιδιαίτερα σε
ασθενείς με καρκίνο κεφαλής και τραχήλου, θα πρέπει να τονιστεί ότι δύο είναι οι άξονες στους οποίους
θα πρέπει ο θεράπων να κατευθύνει τις προφυλακτικές του παρεμβάσεις: α) ο άξονας που αποσκοπεί στη
διατήρηση σταθερού του μικροβιακού φορτίου της στοματικής κοιλότητας και στην πρόληψη εποικισμού
της από εξωγενείς δυνητικά παθογόνους μικροοργανισμούς και β) ο άξονας της διατήρησης της ακεραιότητας
του στοματικού βλεννογόνιου φραγμού και της πρώτης γραμμής άμυνας. Σε περίπτωση δε εκδήλωσης
τοπικής ή γενικευμένης λοίμωξης θα πρέπει να ακολουθούνται κάποιες βασικές γραμμές θεραπείας.
Λέξεις κλειδιά: Στοματίτιδα, Λοιμώξεις, Στοματική φροντίδα, Ακτινοθεραπεία κεφαλής και τραχήλου, Χημειοθεραπεία.
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Τμήμα Στοματικής και Γναθοπροσωπικής Χειρουργικής, Πανεπιστημιακή Κλινική ΑΠΘ, Γ.Π.Ν. «Γ. Παπανικολάου»
(Διευθυντής: Καθ. Δ. Θ. Καρακάσης)
1. Ειδικευόμενη Γναθοχειρουρνός.
2. Αν. Καθ. Γναθοχειρουργικής.
3. Γναθοχειρουργός
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 4(2): 87 - 97, 2003.
ΠΕΡΙΛΗΨΗ
Σκοπός της εργασίας είναι να τονιστεί πως η στοματική κοιλότητα αποτελεί συχνά περιοχή εκδήλωσης
των ανεπιθύμητων ενεργειών της αντικαρκινικής θεραπείας και καθώς οι καρκινοπαθείς έχουν μειονεκτικό
ανοσολογικό σύστημα οι ενδοστοματικές ή συστηματικές λοιμώξεις (μυκητιασικές, ιογενείς, βακτηρι-
διακές) αποτελούν σημαντικές αιτίες θνησιμότητας και νοσηρότητας.
Η επιτυχής πρόληψη και θεραπεία της στοματίτιδας και των συστηματικών λοιμώξεων βασίζονται στη
διατήρηση σταθερότητας στο μικροβιακό φορτίο της στοματικής κοιλότητας του καρκινοπαθούς, στην ακεραιότητα
της πρώτης γραμμής άμυνας του και στην ελάττωση του βαθμού της ανοσοκαταστολής. Στα πλαίσια
της πρόληψης ή της ελαχιστοποίησης των στοματικών λοιμώξεων σε κακρινοπαθείς και ιδιαίτερα σε
ασθενείς με καρκίνο κεφαλής και τραχήλου, θα πρέπει να τονιστεί ότι δύο είναι οι άξονες στους οποίους
θα πρέπει ο θεράπων να κατευθύνει τις προφυλακτικές του παρεμβάσεις: α) ο άξονας που αποσκοπεί στη
διατήρηση σταθερού του μικροβιακού φορτίου της στοματικής κοιλότητας και στην πρόληψη εποικισμού
της από εξωγενείς δυνητικά παθογόνους μικροοργανισμούς και β) ο άξονας της διατήρησης της ακεραιότητας
του στοματικού βλεννογόνιου φραγμού και της πρώτης γραμμής άμυνας. Σε περίπτωση δε εκδήλωσης
τοπικής ή γενικευμένης λοίμωξης θα πρέπει να ακολουθούνται κάποιες βασικές γραμμές θεραπείας.
Λέξεις κλειδιά: Στοματίτιδα, Λοιμώξεις, Στοματική φροντίδα, Ακτινοθεραπεία κεφαλής και τραχήλου, Χημειοθεραπεία.
REFERENCES
Allison RR, Vongtama V, Vaughan J, Skin KH: Symptomatic
acute mucositis can be minimized or prophylaxed by the
combination of sucralfate and flucomazole. Cancer Invest 13:
16-22, 1995.
Αντωνιάδης Β, Αντωνιάδης Κ: Ακτινική βλεννογονίτιδα. Στόμα
27: 77-82, 1999.
Arvin AM, Pollard RB, Asmussen LE, Merigan TO. Cellular and
humoral immunity in the pathogenesis of recurrent herpers
viral infections in patients with lymphoma. J Clin Invest 65:
869-78, 1980.
Beumer J, Brady FA: Dental management of the irradiated
patient. Int J Oral Surg 7: 208-20, 1978.
Biron P, Sebban C, Gourmet R, Chvetzoff G, Philip I, Blay JY:
Research controversies in management of oral mucositis.
Support Care Cancer 8: 68-71, 2000.
Brown DT, Millr CH, Manpin D: The effect of sucralfate on the
growth of cariogenic streptococci. J Prosthet Dent 66: 256-
60, 1993.
Bums WH, Sural R: Opportunistic viral infections. BR Med Bull
41:46-9,1985.
Caratala J, Alcaide F, Fernandez-Sevilla A, Corbella X, Linares J,
Gudiol F: Bacteremia due to viridans streptococci that are
highly resistant to penicillin: increase among neutropenic
patiens with cancer. Clin Infect Dis 20: 1169-73, 1995.
Chen TY, Webster JH: Oral monilia study on patients with head
and neck cancerduring radiotherapy. Cancer 34: 246-51,
1974.
Chi HK Chen CH Chan WK, Chow KC, Chen SY, Yen SH,
Chao JY, Chang CY, Chen KY: Effect of granulocytemacrophage
colony-stimulating factor on oral mucositis in head
and neck cancer patients after cisplatin, fluorouracil, and
leucovorin chemotherapy. J Clin Oncol 13: 2620-8, 1995.
Cronje FJ: A review of the Marx protocols: prevention and
management of osteoradionecrosis by combining surgery
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