術前術後管理に苦慮した中等度精神遅滞を伴った舌癌患者の１例

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  • A case of a tongue cancer patient with moderate mental retardation who posed difficulties in pre- and postoperative management

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We report on difficulties encountered in perisurgical management of an oral cancer patient with mental retardation. The 30-year-old woman patient had moderate mental retardation and was suffering from advanced tongue cancer. We scheduled a subtotal glossoectomy with radical neck dissection together with rectal abdominal free flap reconstruction. Prior to the surgery, preoperative chemoradiotherapy was performed. We tried to explain why she needed the operation and what would happen afterwards using the simplest terms possible and frequent repetition in a step by step manner. We thought that she had acquired a certain level of understanding and consented to the surgery because of the questions she asked in response to our explanations. A couple of days before the date scheduled surgery, however, she developed severe nausea and vomiting with no evident physical cause. This seemed to be a maladaptive reaction due to strong anxiety about the surgery, and the date of the operation had to be postponed. The operation was eventually performed with the help of an antianxiety agent, the use of which was continued to reduce the postoperative mental and physical stress. We sought to develop a better doctor-patient relationship by means of much more frequent communication than usual, but postoperative depression eventually developed about 10 days after the surgery. The experience again demonstrated the difficulty of perisurgical management of mentally retarded patients who need major oral surgery. We suggest that it is especially important to use holistic management techniques, including collaboration with psychosocial specialists during the perisurgical period, when treating patients of this kind.

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