口腔颌面及颈部癌瘤根治性颈廓清术

Study on radical neck dissection for oral maxillofacial and neck regional carcinoma

目的：本文研究了口腔颌面及颈部癌瘤颈廓清根治术的主要技术改进。方法：①颈廓清根治术时不用乙醚全麻方法，而采用普鲁卡因复合静脉全麻。②在手术时给与少量硫喷妥钠全麻。③术后每日静注地塞米松１０～２０ｍｇ，５０％葡萄糖１００ｍｌ，连用１０日。④两侧颈廓清时，必须保留一侧颈内静脉。⑤手术中及术后，坚持保持颈部伸展体位，以维持颈椎外静脉丛的充分伸展。⑥切除两侧颈内静脉时，必须作气管低位切开。⑦术后避免使用压迫绷带。结果：由于采用了上述方法，防止了大脑血管的扩张，减少了大脑水肿的发生，也减少了脑血管出血的意外和术后急性喉水肿引起的窒息等并发症。结论：上述技术改进，减少了颈廓清根治术的并发症，本组３５３例颈廓清根治术死亡率仅为０５６％，低于国内外报告的同类手术死亡率。本组颈廓清根治术成功率为９９４４％（３５１／３５３）。

Objective: Key technological trasformations of neck dissection for oral maxillofacial and neck regional carcinoma was studies. Methods: ①Discared ether anesthesia, and apply procaine complex intravenous anesthesia to neck dissection. ②Combined with smoll amounts of pentothal anesthesia during the operation. ③Venous transfusion dexamethason 10-20 mg. Q.D.and 50% Glucose 100 ml Q.D.continuous 10 days. ④In the bilateral neck dissection, one lateral internal Jugular vein should be left. ⑤Constant through should be direct teward maintaining elasticity external vertebral venousplexus system during the operation and postoperation. ⑥After bilateral internal jugular vein resection must be alow tracheastomy is performed. ⑦Pressure dressing must be avaided. Results: Above mentioned methods prevented cerebrovascular dilatation, edema of brain; reduced accidental intracerebral hemorrhage and suffocation in after operation due to acute laryngeal edema. Conclusion: The aforementioned key technological trasformations reduced complications of nack dissection, the mortality was only 0.56 percent, lower than the international and internal mortality of neck dissection was reported. the radical neck sissection succeed rate was 99.44 percent in this article of 353 cases.