保存颈内静脉的改良根治性颈淋巴清扫术的临床评价

Clinical evaluation of modified radical neck dissection with internal jugularve in preservation

目的 :对口腔癌及口咽癌颈淋巴清扫术中保存颈内静脉术式的临床效果进行评价。方法 :回顾分析本院近 10年内所行的根治性颈淋巴清扫术和保存颈内静脉的改良根治性颈淋巴清扫术病例资料。比较 2种术式的术后面部水肿和颅内高压持续时间及程度、2组患者的术后局部复发情况和生存时间。结果 :保存颈内静脉的改良根治性颈淋巴清扫术的术后颌面部水肿和头晕症状程度轻于根治性颈淋巴清扫术 ,持续时间缩短。改良根治性颈淋巴清扫术 3年和 5年生存率分别是 72 .6%和 5 3 .3 % ,局部复发率 5 .1% ;而根治性颈淋巴清扫术 3年和 5年生存率分别是 75 .2 %和 5 7.8% ,局部复发率 4.8%。二者 3组指标差异均无显著性 (P >0 .0 5 )。结论 :保存颈内静脉的改良根治性颈淋巴清扫术和经典的根治性颈淋巴清扫术临床疗效相近 ,术后并发症轻 ,且能保存颈内静脉 ,为可能的再次手术治疗创造了条件 ,值得临床推广。

Objective:To evaluate the effect of modified radical neck d issection(MRND) with internal jugular vein preservation in the treatment of carc inoma in oral and maxillofacial region. Methods:116 cases with o ral and maxillofacial carcinoma were treated by radical neck dissection(RND) and 87 by MRND.The data of swelling and intracranial hypertension,3-year and 5-ye ar survive rate and recurence were analyzed and compared between groups. Results:Swelling in oral- maxillofacial region and head pain or dizzine ss symptom were slight and lasted a shorter time after operation in the group of MRND than those in the group of RND.3- year survive rate in MRND and RND group was 72.6% and 75.2%(P>0.05),5- year survive rate 53.9% and 57.8%(P>0.0 5),respectively. Recurrent rate in the two groups was 5.1% and 4.8%(P>0.05), lymph node metastasis was 28.5% and 30.2%(P> 0.05 ),respectively. Conclusions:Modified radical neck dissection with internal jugular vein preservation may have similar therapeutic effect to radical neck dissection.