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目的:探索一种保证口腔癌颈淋巴结转移手术彻底性和避免并发症,最大限度保存患者术后生存质量和机体功能的最佳颈清扫术式。方法:通过对182例颈淋巴清扫术的回顾性研究,对保留颈外静脉、颈神经丛深支和耳大神经的颈淋巴清扫术式的根治效果、术中并发症和术后功能障碍进行评价,所得数据进行χ2检验。结果:与常规根治性颈淋巴清扫术相比,保留颈外静脉和颈神经丛深支的根治性颈淋巴清扫术在维持术中较平稳的生命体征、术后恢复等方面具有明显的优势,尤其是接受双侧根治性颈清扫术的病例,保留颈外静脉将降低手术风险和术后护理难度,并有利于患者的尽早恢复,其术后肩功能和耳郭和(或)耳后区皮肤感觉功能明显优于根治性颈清术式(P<0.05),而术后颈部复发率与根治性颈淋巴清扫术无显著差异(P>0.05)。结论:保留颈外静脉和颈神经丛深支的根治性颈淋巴清扫术是一种比较合理的术式,在保证颈清扫根治性的前提下,减轻和避免了术中、术后的颅内高压并发症和肩功能损伤及耳部感觉障碍。本术式适应证广泛,可作为口腔癌颈淋巴结转移和cN0选择性颈清扫术的常规术式。
OBJECTIVE: To explore the best method of neck dissection to ensure the thoroughness of operation and avoid the complications of cervical lymph node metastasis in oral cavity and maximize the postoperative quality of life and body function of patients. Methods: A retrospective study of 182 cases of cervical lymphadenectomy was performed on the radical resection of cervical lymphnodesis which preserved the external jugular vein, the deep branch of cervical plexus and the large auricular nerve. The complications and postoperative dysfunction Evaluation, the data obtained χ2 test. Results: Compared with conventional radical neck dissection, the radical neck dissection preserving the deep branches of the external jugular vein and cervical plexus has obvious advantages in maintaining relatively stable vital signs and postoperative recovery. Especially the case of bilateral radical neck dissection, preservation of the external jugular vein will reduce the surgical risk and postoperative care difficulty, and is conducive to the early recovery of patients, and its postoperative shoulder function and ear and (or) ear area Skin sensory function was significantly better than radical neck dissection (P <0.05), while neck recurrence rate after radical neck dissection and no significant difference (P> 0.05). Conclusion: The radical neck dissection, which preserves the jugular veins and the deep branches of the cervical plexus, is a reasonable surgical procedure. Under the premise of ensuring the radical curative effect of neck dissection, intraoperative and postoperative intracranial High-pressure complications and shoulder dysfunction and ear sensation. This technique is widely used indications, can be used as oral cancer neck lymph node metastasis and cN0 selective neck dissection routine surgery.