同期双颈淋巴廓清术37例分析

Analysis of 37 cases with primary bilateral neck dissection

目的 :探讨同期实施双颈淋巴廓清术提高癌症患者生存率的可能性。方法 :头颈部癌伴双颈淋巴转移 ,在切除原发灶的同时一期行双颈淋巴廓清术。根据淋巴结的大小及分布范围 ,分别采用 4种术式 ,(1)经典性全颈清扫术 ;(2 )改良性全颈清扫术 ;(3)分区性颈清扫术 ;(4 )颈扩大清扫术。结果 :经随访 ,3年生存率为 6 2 .1% (2 3/ 37) ,5年生存率为 37.8% (14 / 37)。并发症有乳糜漏 2例 ,血肿 2例 ,颈皮瓣延期愈合 1例 ,严重面部软组织水肿 5例。无因手术而死亡或偏瘫者。结论 :为了提高癌症患者的生存率及生存质量 ,只要严格掌握手术适应证 ,术中 (至少 )保留一侧颈内静脉 ,同期行双颈淋巴廓清并发症不重 。

Objective:To improve the survival rate of head and neck carcinoma, explore the possibility of primary bilateral neck dissection. Method: 37 cases of head and neck carcinoma with bilateral cervical metastasis were performed resection of primary lesion and primary bilateral neck dissection. Based on the size and sistribution of the lymphnode , four surgical methods were adopted: (1)comprehensive radical neck dissection; (2) modified or function neck dissection; (3) selective neck dissection; (4)extended radical neck dissection. Result: All of the 37 cases of the parapharyngeal space tumors were removed totally under well exposure of the tumors. Conclusion: In order to resect the parapharyngeal space tumors totally and safely, it is reasonable to adopt different surgical approaches according to the sites of the tumors.