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目的:探讨头颈部恶性肿瘤行原发灶切除加同期双侧颈清扫的安全性、适应证及手术难点。方法:回顾分析1998-01-2007-12间134例行肿瘤原发灶切除加双侧颈清扫术头颈部恶性肿瘤患者的临床资料,同期双侧颈清扫术方式分为:一侧根治性颈清扫加一侧功能性颈清扫(29例),一侧根治性颈清扫加一侧侧颈清扫(34例),双侧功能性颈清扫(14例),一侧功能性颈清扫例加一侧侧颈清扫(48例),双侧颈侧清扫6例。结果:134例患者无一例手术死亡,并发症为创口出血3例,乳糜漏4例,咽瘘8例,咽瘘伴颈部清扫区感染1例,消化道应激性溃疡5例,其中1例抢救无效死亡,脑梗塞1例。结论:头颈部恶性肿瘤行同期双侧颈清扫是安全的,但要选择适当的清扫方式,以降低颈部淋巴结转移,减轻患者痛苦。
Objective: To investigate the safety, indications and surgical difficulties of primary tumor resection plus bilateral neck dissection in head and neck malignant tumors. Methods: The clinical data of 134 patients with primary tumor resection plus bilateral neck dissection in patients with head and neck malignant tumor from 1998 to 2007 were analyzed retrospectively. The bilateral neck dissection was divided into two groups: radical one Neck dissection plus one side functional neck dissection (n = 29), side neck dissection plus side neck dissection (n = 34), bilateral functional neck dissection (n = 14), side functional neck dissection plus Side of the neck cleaning (48 cases), bilateral neck side cleaning in 6 cases. Results: There was no surgical death in 134 cases. The complications were wound bleeding in 3 cases, chylous leakage in 4 cases, pharyngeal fistula in 8 cases, pharyngeal fistula with neck dissection in 1 case, gastrointestinal ulcer in 5 cases, of which 1 Case of rescue invalid death, cerebral infarction in 1 case. Conclusion: Bilateral neck dissection in head and neck malignant tumors is safe during the same period. However, proper choice of cleaning method should be used to reduce the metastasis of cervical lymph nodes and relieve the suffering of patients.