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目的:探讨同期实施双颈淋巴廓清术提高癌症患者生存率的可能性。方法:头颈部癌伴双颈淋巴转移, 在切除原发灶的同时一期行双颈淋巴廓清术。根据淋巴结的大小及分布范围,分别采用4种术式,①经典性全颈清扫术; ②改良性全颈清扫术;③分区性颈清扫术;④颈扩大清扫术。结果:经随访,3年生存率为62.1%(23/37),5年生存率为37.8%(14/37)。并发症有乳糜漏2例,血肿2例,颈皮瓣延期愈合1例,严重面部软组织水肿5例。无因手术而死亡或偏瘫者。结论:为了提高癌症患者的生存率及生存质量,只要严格掌握手术适应证,术中(至少)保留一侧颈内静脉, 同期行双颈淋巴廓清并发症不重,手术是安全可行的。
Objective: To investigate the possibility of using double neck lymphadenectomy during the same period to improve the survival rate of cancer patients. Methods: Head and neck cancer with double-neck lymph node metastasis, resection of the primary tumor at the same time a double neck lymphadenectomy. According to the size and distribution of lymph nodes, respectively, using four kinds of surgery, ① classic total neck dissection; ② modified total neck dissection; ③ regional neck dissection; ④ neck dissection. Results: At follow-up, the 3-year survival rate was 62.1% (23/37) and the 5-year survival rate was 37.8% (14/37). Complications of chyle leakage in 2 cases, 2 cases of hematoma, delayed skin flap in 1 case, severe facial soft tissue edema in 5 cases. No death or hemiplegia due to surgery. Conclusion: In order to improve the survival rate and quality of life of patients with cancer, surgery should be safe and feasible as long as strict indications of surgical indications are met, at least one side of the internal jugular vein should be reserved and the complications of double neck lymphadenectomy should not be serious during the same period.