颈淋巴结清扫术不同解剖入路发生乳糜瘘或副神经损伤的经验探讨

Correlations of different approaches in neck dissection with chylous fistula or accessory nerve injury

目的探讨颈淋巴结清扫术不同解剖入路致乳糜瘘或副神经损伤的比较。方法选择中南大学湘雅医院2013年1月-2014年1月行根治性和功能性颈淋巴结清扫术的下咽癌80例,采用数字表随机法分为4组,每组20例,分别采用4种不同的手术入路进行颈淋巴结清扫术暴露颈鞘,观察患者颈淋巴结清扫术中乳糜瘘和副神经损伤情况,暴露度及手术时间。结果 A组并发症发生率为15%;B组为5%;C组为10%;D组为5%;D组在清扫Ⅴ区时发生2例副神经切断;A组并发症发生率高于B组、D组(P<0.05)。4组术野暴露评分由高到低依次是D组、C组、A组和B组。D组、C组Ⅱ、Ⅲ、Ⅳ区术野暴露评分高于A组、B组,D组、C组与A组、B组比较差异具有统计学意义(P<0.05)。结论根据病情选择颈淋巴结清扫的手术入路,熟悉颈部解剖层次,是减少颈淋巴结清扫术并发症发生的关键。

Objective To compare chylous fistula or accessory nerve injury in different surgical approaches of neck dissection. Methods Eighty patients with hypopharyngeal cancer were selected in this study. All of the patients were given radical or functional neck dissection from January 2013 to January 2014. The patients were divided into 4 groups （20 in each group） based on the random table method. Four different approaches were adopted to expose the carotid sheathes of the patients for neck dissection. The patients were observed for chylous fistula, accessory nerve injury, exposure degree （VAS scores） and operation time. Results In this study, the complication rate was 15% in the group A, 5% in the group B, 10% in the group C and 5% in the group D. Two cases had abscission of accessory nerve in region V of the group D. The complication rate of the group A was significantly higher than that of the group B and the group D （P 〈 0.05）. VAS scores from high to low were in the group D, C, A and B. VAS scores of regions Ⅱ, Ⅲ and IV in the group D and the group C were significantly higher than those of the group A and the group B （P 〈 0.05）. Conclusions Surgical approach should be selected according to the condition. The crux of reduction of complications is to be familiar with the anatomy of the neck.