保留耳大神经颈淋巴结清扫术临床分析

Preservation of great auricular nerve in neck dissection

目的总结保留耳大神经颈淋巴结清扫术对提高头颈恶性肿瘤患者生活质量的临床作用,并探讨耳大神经的解剖定位标志作用及合理手术操作流程。方法157侧保留耳大神经颈淋巴结清扫术,随访观察患者耳枕部感觉功能变化情况;观察在胸锁乳突肌后缘处耳大神经与副神经解剖位置关系,测量115侧两者间距离;在相同清扫范围的条件下选取72侧,按是否遵循自定的手术操作流程分为A、B两组,比较两组手术所用时间。结果术后耳枕部感觉功能保留或恢复满意;有17侧出现耳枕部皮肤较为突出的刺痛,约6～9个月感觉恢复正常。在胸锁乳突肌后缘,耳大神经100%位于副神经下方颈外静脉上方,与副神经间距约0.1 cm～1.9 cm。不同手术操作流程的手术用时分别为(132.78±8.82)分钟和(89.44±9.54)分钟,差异有统计学意义(P<0.01)。随访3～9年,手术清扫区域无肿瘤复发。结论保留耳大神经颈淋巴结清扫术是提高患者术后生存质量行之有效的措施,耳大神经是术中重要的解剖定位标志并能形成合理的颈淋巴结清扫术操作流程。

OBJECTIVE To discuss the role of preservation of great auricular nerve during neck dissection in improving the quality of life of the patients and to study the anatomic marks of the great auricular nerve. METHODS Preservation of great auricular nerve during neck dissection was performed in 157 sides of the neck. The feeling changes in auricular and occipital areas were observed. The anatomic relationship between the great auricular nerve and accessory nerve at the posterior margin of the sternocleidomastoid muscle was measured in 115 sides. According to whether to follow the operative steps decided in neck dissection, 72 sides with same neck dissection levels were divided into group A and group B. The surgical time of the two groups were recorded. RESULTS At the posterior margin of the sternocleidomastoid muscle, the great auricular nerve located under the accessory nerve and above the external jugular vein in 100 % patients. The distance between the great auricular nerve and accessory nerve was 0.1 to 1.9cm. There was a significant difference in surgical time between the two groups （P 〈 0.01）. All the cases remained good feeling in the auricular and occipital areas after operation. Only 17 sides had prominent stabbing pain in auricular and occipital skin and restored normally within 6 to 9 months. No local recurrence of tumor was found during follow-up for 3 to 9 years. CONCLUSION Preservation of great auricular nerve during neck dissection can improve the quality of life of the patients. The great auricular nerve is an important anatomic mark in operation.