Нутрітивний статус у хворих з раком порожнини рота та ротоглотки в предопераційному періоді

Abstract

Head and neck tumors are a significant group of malignant neoplasms. Dysphagia is one of the most important problems in the nutrition of patients with tumors of the oral cavity and oropharynx. It is present in almost every patient and accounts for 90-95% of cases, both in the preoperative and postoperative period. Problems with swallowing in head and neck cancer may be related, first of all, to the type and size of the tumor itself, which disrupts the ability to eat. Disturbance in the pushing of the food lump develops as a result of dysfunction of the affected muscles or damage to peripheral nerves. There are also early and late disturbances of normal swallowing after radiation and chemotherapy for malignant tumors of the oral cavity, oropharynx, and larynx. Such patients already have a nutritional deficiency in the preoperative period. The purpose of the study was to assess the frequency of nutritional insufficiency in patients with oncology of the oral cavity and oropharynx in the preoperative period and to identify the most significant criteria for nutritional status violations. Materials and methods. The study was conducted in 41 patients, aged 38-55 years (35 men, 6 women) with stage I-III of malignant tumors of the lips, tongue, floor of the mouth and oropharynx. We determined the dynamics of weight in cancer patients with pathology of the oral cavity and oropharynx from the onset of the disease and at the stages of treatment. The patient was weighed at the time of hospitalization and in the postoperative period for 3, 5, 7, 9, 12 days. Anamnestically, weight was determined 3-6 months after the first signs of the disease. Body mass index, shoulder circumference and thickness of the skin-fatty fold of the triceps were measured and calculated, as well as laboratory indicators – biochemical markers: total protein, albumin, transferrin, absolute number of lymphocytes. Results and discussion. The patient's weight loss before the first signs of the disease averaged 6-8 kg. In the postoperative period, a gradual weight loss was noted until the ninth day after the operation, and then weight stabilization was observed. In nine days, patients lost 4-7 kg of weight from the time of hospitalization. The fastest weight loss was observed in the period of 3-7 days of the postoperative period. The average values of anthropometric indicators in the studied group, with the exception of a moderate decrease in the size of the skin-fatty fold in men, were within the normal range. A decrease in the absolute number of lymphocytes, less than 1.5 thousand in 1 μl (p <0.05), was noted in 71% (29/41). Indicators characterizing the visceral protein pool (total protein, transferrin) were also within normal values, except for albumin, which was slightly reduced in 63%. Conclusion. A comprehensive study revealed in the preoperative period in patients with oncopathology of the oral cavity and oropharynx a high incidence of malnutrition (85%). The main contribution to the change of trophological status is a decrease in the cellular component of immunity and albumin