颌下-半颈发际缘切口行全颈淋巴清扫术的探讨

Clinical study on application of submandible-semicervix hairline incision in radical neck dissection (a new incision for neck dissection—Zhang's incision)

目的本研究首次采用颌下-半颈发际缘切口行单侧和双侧全颈淋巴清扫术，探讨其临床可行性。方法选取中山大学附属口腔医院2006年11月至2007年1月入院的舌癌患者3例，采用颌下，半颈发际缘切口行单侧颈淋巴清扫术。选取2007年1月至11月4例恶性肿瘤患者，采用颌下，半颈发际缘切口行双侧颈淋巴清扫术。单侧颈淋巴清扫术切口由颌下切口及半颈发际缘切口组成，颌下切口位于下颌下2～3cm。并与下颌下缘平行。尽量位于皮纹中，前至对侧颏部，后至乳突尖；然后由乳突尖处转折向下，沿发际缘下行至颈中份处。双侧颈淋巴清扫术则由双侧颌下切口及双侧半颈发际缘切口组成。单侧或双侧颈淋巴清扫术均在颈阔肌深面翻瓣后，合理利用手术拉钩牵引，充分暴露手术空间。术中评估操作的可行性及难易程度，术后观察切口愈合情况及瘢痕大小。结果该切口单侧颈淋巴清扫术中暴露虽然不如类矩形切口，但通过合理牵拉仍能充分暴露术区，完成手术；手术操作有一定难度，需要手术医生具有丰富的颈淋巴清扫术的经验，耗时相对较长。双侧颈淋巴清扫术该切口暴露比平行切口较好，但不如“H”形切口和“T”形切口。然而通过合理牵引拉钩，能充分暴露术区，完成手术。3例单侧和4例双侧颈淋巴清扫术患者术后创口愈合良好，瘢痕较小。结论颌下，半颈发际缘切口行单侧或双侧全颈淋巴清扫术，皮瓣血运好，手术反应小，瘢痕形成少。外形美观。减轻患者心理创伤，有利于提高患者生活质量。适用于年轻的和对美观较为重视的选择性颈淋巴清扫术患者。

Objective The purpose of this study is to study the effect of the modified incision originally proposed by our group, called submandible-semicervix hairline incision （Zhang＇s Incision）, and to evaluate its clinical feasibility and results. Methods Since November 15, 2006 to January 11, 2007, 3 tongue carcinoma （T2N0M0） cases in stomatology hospital of Sun Yat-Sen University were chosen for the research. 2 out of the 3 patients were male. The average age was 54. All the patients received glossectomy combined with elective neck dissection and tracheotomy. Another 4 cases of oral malignancy who received bilateral neck dissection were also chosen. Submandible incision and semicervix hairline incision was used in the operation. The incision included a horizontal submandible incision located 2 ～ 3 cm below the mandibular margin, and a hairline incision run from the mastoid to the mid cervix. In those who underwent bilateral neck dissection, the incision composed of submandible incision and semicervix hairline incision on both side. The feasibility and difficulty of the operation using this incision were observed, and the prognosis and post-operative scar formation were evaluated. Results All patients recovered smoothly. No flap necrosis and obvious sear was observed. However, because of the insufficient exposure, the process became more time consuming, and experiences required. In case of bilateral neck dissection, the new incision could provide better exposure than using parallel （Macfee） incision, but not as good as that of ‘H＇or‘T＇ shape incision. Conclusions Submandible-semicervix hairline incision （Zhang＇s Incision） for neck dissection had better blood supply and wound healing. The minimized scars improved the patients＇ quality of live. It provided better choice for those have higher cosmetic requirements. In conclusion, Submandiblesemicervix hairline incision is feasible and reasonable. It is a new approach for neck dissection especially for bilateral neck dissection.