保留颈外静脉，耳大神经和颈神经丛深支的根治性颈清扫术疗效评价

目的：评价保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术疗效。方法：2001年6月至2003年12月住院的口腔癌初诊患者40例,均经病理确诊,其中男23例,女17例,年龄31—60岁,平均年龄48岁,中位年龄50岁,舌癌16例,颊癌15例,口底癌5例,下牙龈癌4例。所有患者分为两组,分别行经典的根治性颈淋巴清扫术和保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术。结果：术后切口均I期愈合,与经典的根治性颈淋巴清扫术相比,保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术在功能保留方面明显优于经典的根治性颈淋巴清扫术（P〈0．05）,而术后颈部复发率与经典的根治性颈淋巴清扫术无显著差异。结论：保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术可作为口腔癌颈清扫术的常规术式,并易于临床推广。     

合理的根治性颈淋巴清扫术的临床应用评价

目的:评价保留颈外静脉、耳大神经和颈神经丛深支的新型改良根治性颈淋巴清扫术(或称合理的根治性颈淋巴清扫术)在治疗口腔癌颈淋巴转移灶中的临床应用价值。方法:TNM分期在T2N1M0~T4N3M0之间的口腔鳞癌初诊患者45例,随机分为2组(RND组和RRND组),RND组行传统根治性颈淋巴清扫术(22例),RRND组行合理的根治性颈淋巴清扫术(23例),比较2种手术方式的颈淋巴结术后复发率和并发症。结果:RRND组术后患者面部水肿及头晕、头痛症状显著低于RND组(P<0.05);术后6个月复查,RRND组患者耳廓和肩部麻木感显著低于RND组,耳廓皮肤感觉功能和肩运动功能显著高于RND组(P<0.05);随访3年,RRND组和RND组术后颈淋巴结复发率分别为8.70%、4.55%,差别无统计学意义(P>0.05)。结论:合理的根治性颈淋巴清扫术与传统根治性颈淋巴清扫术相比,不会增加术后颈淋巴结复发率,但极大地提高了患者术后的生存质量。     

保留颈深神经和颈外静脉的改良颈淋巴清扫术的临床研究

根治口腔鳞癌时采用传统的颈淋巴清扫术常行整块颈部组织切除,由此会带来一些不可避免的术后并发症,对患者肩功能造成严重的影响。笔者采用保留颈外静脉及颈神经丛深支的颈淋巴清扫术,大大降低了患者术后并发症的发生率,提高了患者的生存质量,现将结果报道如下。1对象和方法1.1     

保留颈外静脉及颈丛神经深支颈淋巴清扫术式的相关基础研究

目的　研究保留颈外静脉及颈丛神经深支对颈淋巴清扫术的安全性、彻底性及术后颅内和面部静脉回流的影响。方法　20例口腔鳞癌患者均采用联合根治术并保留颈神经丛深支。按保留颈外静脉与否将患者随机分为两组,每组10例。检测患者术前、术后的面部组织间质压,免疫组织化学技术染色淋巴管并计数其密度,观察记录患者的术后主观症状。结果　保留颈外静脉组术后面部组织间质压的升高及持续时间均低于不保留组。颈部不同结构淋巴管密度的均值由高至低依次为:颈内静脉、胸锁乳突肌、副神经、颈外静脉和颈丛深支。结论　保留颈外静脉及颈丛神经深支不影响颈淋巴清扫术的安全性及彻底性,并可有效改善患者术后颅内和面部的静脉回流,保存肩功能。     

根治性颈淋巴清扫术改善术后肩功能的方法探讨

目的 探讨一种改进根治性颈清扫术式对术后肩功能的影响。方法 随机选择20例需行颈清扫术的患者分为2组，每组10例。试验组行根治性颈清扫术时保留颈丛深支，对照组行常规根治性颈清扫术。术后3周及6个月随访．对术后患侧斜方肌功能进行评价。结果 术后3周两组患者均有不同程度的肩功能受损；术后6个月试验组患者患侧肩部无明显下垂，患侧上肢外展稍超越水平线。对照组患侧肩部有不同程度下垂，肩部疼痛，麻木，上肢外展不能超过水平线。结论 保留颈丛深支的根治性颈淋巴清扫术能明显改善术后患侧的肩臂功能，减轻传统术式术后肩部的疼痛、麻木感。该术式不影响根治颈清扫术的疗效，易于临床开展。     

颈神经丛深支对斜方肌运动功能的影响

目的　探讨颈神经丛深支在斜方肌运动功能中的作用。方法　采用电生理方法 ,测定切断副神经后的不同时期 ,刺激颈神经丛深支在大鼠斜方肌得到的肌电大小 ,并作统计学分析。结果　保留颈神经丛深支 ,术后不同时期 ,在大鼠斜方肌上均能测到肌电且肌电值差异有显著性。结论　颈神经丛深支是支配斜方肌的另一运动神经来源 ,根治性颈清扫术中对该神经的保护能有效地预防肩综合征的发生。     

颈淋巴清扫术后肩综合征的防治

探讨预防颈清扫术后肩综合征的方法。方法观察１１例接受根据治性颈清扫术患者，其中８例切降副神经，保留颈神经丛深支，３例同时切降副神经及颈神经丛深支，术后６月进行肩功能的临床和斜方肌骨电检查。     

肩胛舌骨上颈清扫术对cN0口腔癌患者颈部复发影响的Meta分析

目的:评价肩胛舌骨上颈清扫术对cN0口腔癌患者颈部转移及复发的影响。方法:评价国内外1985～2004年公开发表的关于肩胛舌骨上颈清扫术与根治性颈淋巴清扫术对cN0口腔癌患者颈部转移及复发影响的对照研究,研究组接受肩胛舌骨上颈清扫术,对照组为根治性颈淋巴清扫术,结局变量为研究组与对照组颈部区域转移及复发率,应用RevMan4.2.2进行Meta分析。结果:肩胛舌骨上颈清扫组的转移及复发优势比OR=1.34,95%置信区间[0.74,2.43],表明肩胛舌骨上颈清扫组与根治性颈清扫组比较,对cN0口腔癌患者术后颈部转移及复发影响的差异无统计学意义。结论:对于cN0口腔癌患者的颈部淋巴结处理,肩胛舌骨上颈淋巴清扫术与根治性颈淋巴清扫术的治疗效果一样,无显著差异。但由于某些偏倚因素可能影响结果,此结论仅供参考,尚需待新研究出现时予以再次论证。     

颈清扫术不同术式对cN0口腔鳞状细胞癌患者肩功能的影响

目的比较颈清扫术（ND）不同术式对口腔鳞状细胞癌患者术后肩功能的影响.方法将66例临床颈部淋巴结阴性（cN0）口腔鳞状细胞癌患者按接受ND的术式分为根治性颈清扫术（RND）组、改良根治性颈清扫术（MRND）组和择区性颈清扫术（SND）组,采用Constant＇s肩功能量表和ND损伤指数量表对术后肩功能进行评价.结果保留副神经组的患侧肩功能优于RND组（P＜0.01）.在保留副神经组中,SND组的肩功能优于MRND组（P＜0.01）.SND术后的肩部疼痛和功能障碍轻微.结论SND对术后肩功能影响轻微,优于RND和MRND.     

保存颈内静脉的改良根治性颈淋巴清扫术的临床评价

目的 :对口腔癌及口咽癌颈淋巴清扫术中保存颈内静脉术式的临床效果进行评价。方法 :回顾分析本院近 10年内所行的根治性颈淋巴清扫术和保存颈内静脉的改良根治性颈淋巴清扫术病例资料。比较 2种术式的术后面部水肿和颅内高压持续时间及程度、2组患者的术后局部复发情况和生存时间。结果 :保存颈内静脉的改良根治性颈淋巴清扫术的术后颌面部水肿和头晕症状程度轻于根治性颈淋巴清扫术 ,持续时间缩短。改良根治性颈淋巴清扫术 3年和 5年生存率分别是 72 .6%和 5 3 .3 % ,局部复发率 5 .1% ;而根治性颈淋巴清扫术 3年和 5年生存率分别是 75 .2 %和 5 7.8% ,局部复发率 4.8%。二者 3组指标差异均无显著性 (P >0 .0 5 )。结论 :保存颈内静脉的改良根治性颈淋巴清扫术和经典的根治性颈淋巴清扫术临床疗效相近 ,术后并发症轻 ,且能保存颈内静脉 ,为可能的再次手术治疗创造了条件 ,值得临床推广。     

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颏神经、颊神经及鼻腭神经都是周围神经的一部分。周围神经损伤的并发症是指各种因素对周围神经组织的损伤所引起的一系列神经症状或疾病。颊神经及鼻腭神经损伤可以迅速恢复,一般不产生影响;但颏神经损伤导致的感觉功能异常是很严重的并发症,会对患者的工作和生活造成严重影响。本文就拔牙导致周围感觉神经损伤的诊断、处理方法,以及颏、颊及鼻腭神经损伤的原因、临床表现、诊断、处理方法、防治措施做一阐述。     

Prefabricated nerve conduits advance histomorphological and functional outcomes in nerve regeneration of the sciatic nerve of the rat

Bridging a nerve defect is sometimes necessary to achieve nerve regeneration after injury. Different methods and conduit designs have been considered, but only isograft transplants or prefabricated conduits are available. This study presents a comparison of prefabricated conduits and isograft transplants in rats, with the aim of making suggestions for clinical settings. In rats of inbred strains LEW and DA, a 1.5 cm defect of the sciatic nerve was reconstructed by isograft (n = 10) or conduit (n = 10). Untreated rats (n = 10), sham-operated rats (n = 10) and nerves of the non-operated contralateral limb served as controls. Regeneration was evaluated by histomorphological examination and with walking track analysis of the ankle stance angle (ASA) and the sciatic functional index (SFI). After 16 weeks, myelinization and ASA in the conduit group were significantly superior to that in the isograft group. There was no significant difference in SFI between the groups. Reconstruction in the isograft group showed a negative impact on the non-operated side. Conduits and isografts did not reach the morphological or functional levels of untreated or sham-operated animals. The results suggest preferential conduits should be used for nerve reconstruction.     

Relation of mental nerve with mandibular branch of the facial nerve

The aim of this study is to elucidate the detailed anatomical relation of mental nerve with marginal mandibular branch of the facial nerve. Twenty-three hemi-faces of adult Korean cadavers (11 Male and 7 female) were dissected. All locations of crossing (C) of marginal mandibular branch of the facial nerve and mental nerve were measured below the inferior verge of the lower vermillion (V): a vertical distance (V-Gn) between V and gnathion (Gn) and horizontal distance (V-OC) between V and oral commissure (OC). The mental foramen located at 19.8 +/- 4.4 mm below the inferior verge of the lower vermillion (V) and 34.3 +/- 5.2 mm laterally from the midline. In all specimens there were found interconnections between marginal mandibular branch of the facial nerve and mental nerve. The number of connecting site was 8.26 +/- 2.49. Microscopically, both of the nerve branches had a common epineurium, but the perineurium separated. V-Gn and the vertical distance between V and the connecting point (C) was in the ratio of approximately 2:1, and V-OC and the horizontal distance from V:C was an equal ratio. The proximity of the mental nerve and marginal mandibular branch of the facial nerve to each other draws an attention as operating the mental area.     

Horizontal branch of the supraorbital nerve and temporal branch of the facial nerve

The aim of this article is to describe anatomical detail of the course and territory of the horizontal branch of the supraorbital nerve, which connects with temporal branch of the facial nerve. Eighteen hemifaces of Korean cadavers (11 male, 7 female) fixed in 10% formaldehyde solution were dissected. All 18 specimens had horizontal branch of the supraorbital nerve. The horizontal branch emerges out of the supraorbital foramen, runs upward about 12 mm, and then turns laterally at an angle of 104.7 degrees toward the end of the eyebrow. The average number of horizontal branches was 1.7 +/- 0.8. The skin boundary supplied by the horizontal branch was a circle with a diameter of 30 mm. The center was located at 30 mm lateral to the supraorbital foramen and 12 mm above. Grossly, the horizontal branch of the supraorbital nerve connected with the temporal branch of the facial nerve in 8 of 18 (44%) specimens. Microscopically, both nerve branches had common epineurium, but the perineuria were separated. The horizontal branch of the supraorbital nerve is in touch with the temporal branch of the facial nerve, and there are actual connections between them in 44% of cases.     

Intraneural topography of the extratemporal facial nerve: microsurgical nerve reconstruction

The fascicular pattern is the most important component of a nerve when a microsurgical reconstruction is made. The intraneural topography of the extratemporal facial nerve does not have a reliable fascicular pattern, although our study in 25 extratemporal facial nerves showed a definite fascicular pattern in the different studied levels. The microanatomic intraneural investigation was made in four different levels; we studied the diameter of the trunk, number and diameter of each fascicle, fascicular pattern, characteristics of the epineurium, perineurium, and interfascicular connective tissue, and extra- and intraneural blood supply. In the proximal and distal facial trunk, most axons are included in one to three big funiculus surrounded by a small amount of connective, interfascicular tissue; both epineurium and perineurium are thin and slender. The principal arteries are placed between funiculus and epineurium. Either epineurial or interfascicular neurorrhaphy could be produced and mono- or polyfascicular nerve grafts can be used. In both temporofacial and cervicofacial primary branches, the fascicular distribution was from four to five fascicles in 64% of cases with abundant connective interfascicular tissue involving the principal arteries. The interfascicular surgical technique is of election, but the epineurial suture must not be discarded. Nerve graft must be polyfascicular. The goal of nerve repair is to obtain the restoration of anatomic continuity of the most of axons by means of a complete fascicular alignment, in which detailed knowledge of the intraneural topography of the facial nerve must be required for reliable microsurgical reparation.     

Mental nerve exeresis extended to involve the lower alveolar nerve

The author describes an original method of exeresis of the mental nerve bundle extended to involve the lower alveolar nerve. The experience is based on 500 cases of trigeminal neuralgia treated since 1949 by this method.