颈部无痕的舌癌颈淋巴清扫与游离皮瓣修复技术

颈淋巴清扫和修复重建是口腔癌治疗的两大重要内容。颈淋巴清扫和修复重建手术方法多种多样,但都是在开放手术下完成。该文报道一种经耳后发际入路完全腔镜下的颈淋巴清扫术;同期口内肿瘤根治性切除和经口原位血管吻合的旋髂浅动脉穿支皮瓣修复。颈淋巴清扫切口位于发际内,隐匿不可见,术后颈部无暴露性手术疤痕。现就这一术式作以介绍,并对其优缺点进行讨论。     

经耳后发际切口行下颌下腺切除术的临床总结

目的:探讨经耳后发际切口行下颌下腺切除术的可行性、术后并发症及美容效果.方法:此次临床总结纳入的患者共计63例,均来自福建医科大学附属三明市第一医院口腔颌面外科,于2015年1月—2020年10月期间以单侧下颌下腺良性病变为诊断收入院,均行患侧下颌下腺切除术.在这些患者中,38例采用传统的颌下手术切口入路(颌下切口组),25例采用耳后发际切口入路(耳后发际切口组).我们记录并比较2组的手术成功率、手术时间、神经损伤情况、术后面动、静脉出血及美容效果.结果:颌下切口组和耳后发际切口组所有患者的手术均顺利完成.在手术时间上,颌下切口组平均手术时间是(42.47±6.59)min,耳后发际切口组平均手术时间是(89.28±9.69)min,存在显著统计学差异(P<0.01).颌下切口组无神经损伤表现及术后面动、静脉出血,耳后发际切口组只有术后耳垂暂时性麻木3例,无面神经下颌缘支、舌神经及舌下神经损伤表现及术后面动、静脉出血.术后美容效果方面,颌下切口组的美容效果评分平均为4.42分,而耳后发际切口组的评分平均为8.04分,有显著统计学差异(P<0.01).结论:经耳后发际切口入路行下颌下腺切除术是一种安全可行的手术方法,而且相比传统的颌下切口入路,它的美容效果更好.     

414例全颈淋巴清扫术的并发症及其防治

颈淋巴清扫术是控制口腔颌面部癌瘤经颈淋巴结转移的有效方法之一,已被广泛应用于临床.其术式按解剖范围可分为:单侧全颈淋巴清扫术,双侧全颈淋巴清扫术,部分颈淋巴清扫术(舌骨上、肩胛舌骨肌上),联合根治术;按治疗目的可分为:治疗性颈淋巴清扫术,选择性颈淋巴清扫术;按手术方式可分为:传统性颈淋巴清扫术,功能性颈淋巴清扫术.     

单侧颈淋巴清扫术应用各种麻醉方法的体会(附262例)

颈淋巴清扫术是控制口腔颌面部癌肿经颈淋巴结转移的有效方法之一。视原发灶及区域淋巴结的不同情况,可分为颈上部淋巴清扫术、单侧及双侧颈淋巴清扫术;以及选择性或治疗性淋巴清扫术。临床上多为单侧颈淋巴清扫术与原发灶同时大块切除的联合     

沿下唇正中及颌下入路切除上颌骨

目的根据上颌骨解剖学的特点,探讨经下唇、颌下入路行上颌骨切除术的方法及优势。方法24例患者采用这种入路施行上颌骨切除术,即下唇正中至颏下,经患侧颌下至乳突前下方。切口设计避开了上唇及眶下区,最大程度地保持了上唇及面中部软组织结构的完整性,面部切口暴露短,且有利于上颌骨恶性肿瘤扩大根治术以及同期施行颈淋巴清扫术。结果经过0.5~2·0年的术后随访,疗效满意。患者无论是采用单一手术或辅以放、化疗均未出现颌面部皮肤的坏死或口角歪斜等并发症,但有术后短期的下唇麻木。结论沿下唇正中及颌下入路切除上颌骨,不但能充分显露术野、完整切除上骨的恶性肿瘤,并能较满意地保持术后面部外形和功能。     

口腔鳞癌颈淋巴清扫术并发症的临床分析

目的:探讨头颈部鳞癌以改良Schobinger切口行颈淋巴清扫术的术后并发症发病率及防治方法。方法:回顾性分析1994-01-01—2012-12-31期间收治的,原发口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)并采用改良Schobinger切口行颈淋巴清扫术的,429例患者临床资料,对其术后并发症进行回顾性分析总结。结果:429例患者术后并发症发生率为16.55%,其中术后最常见的并发症是涎瘘(6.29%),其次为面神经下颌缘支神经损伤(3.96%)。围手术期无死亡病例,无重大神经、血管并发症发生。结论:基于本文统计数据分析,口腔鳞癌颈清术后的常见并发症为涎瘘(6.29%)和面神经下颌缘支神经损伤(3.96%);改良Schobinger切口适用于口腔鳞癌颈淋巴结清扫术;围手术期采取预防措施可降低颈淋巴结清扫术的术后并发症发生。     

保留颈外静脉、颈神经丛深支和耳大神经的根治性颈淋巴清扫术疗效评价

目的：探索一种保证口腔癌颈淋巴结转移手术彻底性和避免并发症，最大限度保存患者术后生存质量和机体功能的最佳颈清扫术式。方法：通过对182例颈淋巴清扫术的回顾性研究，对保留颈外静脉、颈神经丛深支和耳大神经的颈淋巴清扫术式的根治效果、术中并发症和术后功能障碍进行评价，所得数据进行X^2检验。结果：与常规根治性颈淋巴清扫术相比，保留颈外静脉和颈神经丛深支的根治性颈淋巴清扫术在维持术中较平稳的生命体征、术后恢复等方面具有明显的优势，尤其是接受双侧根治性颈清扫术的病例，保留颈外静脉将降低手术风险和术后护理难度，并有利于患者的尽早恢复，其术后肩功能和耳郭和（或）耳后区皮肤感觉功能明显优于根治性颈清术式（P〈0．05）．而术后颈部复发率与根治性颈淋巴清扫术无显著差异（P〉0．05）。结论：保留颈外静脉和颈神经丛深支的根治性颈淋巴清扫术是一种比较合理的术式，在保证颈清扫根治性的前提下，减轻和避免了术中、术后的颅内高压并发症和肩功能损伤及耳部感觉障碍。本术式适应证广泛，可作为口腔癌颈淋巴结转移和cN0选择性颈清扫术的常规术式。     

颈淋巴清扫术中颈交感神经干的解剖变异

颈淋巴清扫术引致颈交感神经干损伤出现的Horner氏征(瞳孔缩小,上睑下垂,短暂面潮红、无汗)常为人们所忽视。 由一操作者对12具保存尸体仿行双侧根治性颈淋巴清扫术,切除胸锁乳突肌及颈内静脉,解剖翻开颈     

经口腔机器人手术治疗头颈癌的初步经验

该文旨在研究经口腔机器人手术（TORS）治疗头颈部恶性肿瘤的技术可行性、安全性及有效性。对应用daVinci外科机器人治疗的20例患者进行前瞻性研究。纳入标准为成年患者的早期头颈癌，包括口腔癌、口咽癌、下咽癌及喉癌。结果，2例无法充分达到手术部位，手术终止。其他18例术后手术切缘阴性。8例行组织重建。10行单侧颈淋巴清扫，5例行双侧颈清，未行气管切开，术中、术后无并发症。     

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。     

单侧颈淋巴清扫术切口的研究进展

常见单侧颈淋巴清扫术切口包括T形或Y形切口、矩形切口、围裙式切口等.这些颈淋巴清扫术的切口各有其优缺点,临床医生也总在不断尝试和探索新的切口.本文就单侧颈淋巴清扫术切口的进展情况进行综述,探讨各类切口的优缺点,以供临床参考.     

近发际缘冠状切口的设计及临床应用解剖学研究

目的：进行颞区及腮腺区的解剖学研究,为颧骨复合体骨折手术中应用近发际缘冠状切口提供依据,以减少并发症的发生。方法：利用5具经4％甲醛固定的成人男性标本,对颞区及腮腺区相关解剖进行观察、摄像,同时结合12例颧骨复合体骨折患者,应用近发际缘冠状切口实施手术。结果：12例患者手术顺利,术后随访3个月-1a,无术后并发症发生。结论：熟知颞区及腮腺区的解剖,可明显减少手术创伤及预防手术并发症的发生。     

Comparison between hockey stick and reversed hockey stick incision: gently curved single linear neck incisions for oral cancer.

Hockey stick incision (HSI) and reversed-HSI are known to be useful incisions for lymph node dissections of the neck. Both are gently curved single linear incisions without three-point suture line junctions, but are different at the base of the skin flap. The HSI allows the elevation of a superiorly-based single cervical skin flap and the reversed-HSI allows for an inferiorly-based flap. We compared the viability of the skin flaps, exposure of the operation field and cosmetic results to evaluate the characteristics of each incision. HSI appeared to be the suitable incision for radical neck dissection due to adequate exposure of the operation field while rendering excellent cosmetic results. Reversed-HSI was applied in combination with block resection of parts of the oral cavity because it provided much better exposure of the operation field than HSI, while still achieving acceptable cosmetic results. Using this technique, a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to poor blood supply.     

Modification of MacFee Incision: A Balance Between Cosmesis and Accessibility

Incision design is a critical element of operative planning. Incisions are chosen with the aim of optimizing exposure of relevant neck levels and minimizing morbidity. Various incisions have been proposed over the years but none fulfilled the criterias of ideal incisions. We propose a modification of MacFee s incision which is the balance between cosmesis and exposure.     

鼻唇沟微笑切口入路在后颊癌根治术中的应用

目的 探讨应用鼻唇沟微笑切口入路进行后颊癌根治手术的可行性并评价其临床效果。方法 选取2016年8月—2017年3月间行手术治疗的23例后颊癌患者,完成颈部淋巴结清扫术后,在口角外1 cm处的鼻唇沟内设计切口线,即微笑切口。切口呈弧形,向上至鼻翼外下缘,向下与颈淋巴清扫术切口连续。结果 23例患者的原发灶术中显露满意,切缘肿瘤细胞均为阴性。术后随访12~22个月,平均16.5个月,所有患者恢复良好,未见肿瘤复发及远处转移。开口度基本恢复正常,面部切口仅在鼻唇沟处遗留隐蔽的类似“微笑”样的瘢痕。结论 经鼻唇沟微笑切口入路切除后颊癌,术野显露满意,手术操作便利,在不影响肿瘤根治的前提下避免了对患者口裂完整性的破坏,有助于患者开口度的恢复,切口瘢痕隐蔽,值得临床推广应用。     

Minimally-invasive endoscopically-assisted neck dissection for lateral cervical metastases of thyroid papillary carcinoma

Traditional open operations for lateral neck dissection in patients with papillary thyroid carcinoma leave an unsightly scar. We report complete lateral neck dissection and thyroidectomy for papillary thyroid carcinoma using an endoscopically-assisted approach through a small incision, and evaluate its feasibility and safety. Between March 2010 and January 2013, 6 patients with no definite metastases to the lymph nodes at levels II-IV, and 20 with definite metastases to the lymph nodes at levels II-V were selected. Thyroidectomy, dissection of the central compartment (level VI), and ipsilateral level II-IV and II-V neck dissections were done through a small incision in the neck. The steps of endoscopic lateral neck dissection were similar to those of conventional operations. The mean operating time for the whole procedure was 3.57 hours (range 2.5 - 5.0). It was successful in all patients and there were no serious complications or serious blood loss. A total of 21 patients had lymph node metastases in the central and lateral zones. The mean yield of lymph nodes was 38.6 (range 16-61). There was no evidence of residual or recurrent disease at follow-up, and the cosmetic result was excellent. Minimally invasive, video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe, and has excellent cosmetic results. Further studies with a larger number of patients and long-term follow-up are needed to verify its oncological validity.     

耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的应用

目的 探讨耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的临床效果.方法 采用耳后发际联合耳屏缘切口对20例腮腺上极良性肿瘤行手术治疗并分析其疗效与美容效果.结果 20例患者腮腺上极良性肿瘤均被顺利完整切除,术中冰冻及术后常规病理报告均为良性.术后2例出现暂时性耳垂麻木,1例出现暂时性面神经颧支麻痹,1例发生术后涎瘘;所有病例无味觉出汗综合征、无术后出血、无皮瓣坏死等并发症,随访24~48月,未见复发,手术切口疤痕不明显,美容效果满意.结论 腮腺上极良性肿物切除术应用耳后发际联合耳屏缘切口术式安全、可行,切口隐蔽.     

发际内头皮冠状切口在颧骨颧弓骨折治疗中的应用

目的:观察头皮冠状切口在颧骨颧弓骨折中重建骨骼形态的效果。方法:应用发际内头皮冠状切口进路对21例颧骨颧弓骨折病例进行复位和固定,分析其治疗方法的优越性、效果、并发症及预防措施。结果:21例患者术后面型和功能恢复良好。结论:头皮冠状切口对颧骨颧弓三维结构的重建具有手术视野暴露好,操作方便,复位精确,面部不遗留疤痕等优点。     

Benign submandibular gland tumours: outcomes of gland-preserving excision by endoscopic or conventional approach

Endoscope-assisted surgery is becoming a preferred technique in salivary gland surgery. However, this technique has not yet been applied in submandibular gland (SMG) preservation surgery. This retrospective study was performed to evaluate the outcomes of endoscope-assisted gland-preserving surgery through a hairline incision in patients with benign SMG tumours. The study included 38 patients with benign SMG tumours who underwent tumour excision with gland preservation: 19 who underwent local excision of the tumour through an endoscope-assisted hairline approach and 19 who received the conventional cervical approach. The feasibility of the surgical procedure, perioperative patient variables, and postoperative appearance and functional outcomes were evaluated. Patients in both groups had their tumours removed successfully with tumour-free margins. The intraoperative blood loss, postoperative amount of drainage, mean length of the incision, and unstimulated saliva flow rate did not differ between the two groups. There was no difference in the stimulated saliva flow rate between the preserved gland and unaffected SMG. The aesthetic result was better in the endoscope-assisted hairline incision group. No tumour recurrence occurred during follow-up (range 12–52 months). Thus, gland-preserving tumour dissection appears to be a safe method for benign SMG tumours, with good functional results. Furthermore, the endoscope-assisted hairline incision is a feasible method with excellent cosmetic results.     

改良耳颞手术切口在颧骨颧弓骨折联合手术中的应用

目的：在颧骨颧弓联合骨折手术中,探寻一种优于头皮冠状切口的手术进路。方法：改良耳颞手术切口,用于颧骨颧弓骨折开放复位病例35例,观察该手术进路的术区显露程度,术中出血情况,术区皮肤弹性及神经功能情况,了解患者对手术切口的满意度。结果：35例患者均可显露整个颧弓上部及眶外侧缘,满足颧骨颧弓联合手术的显露需要,术中出血少,手术切口均I期愈合,没有出现颞区麻木及面瘫症状,术后半年皮肤弹性良好者33例,达94.29%。患者对切口的满意度100%。结论：改良耳颞手术切口优于头皮冠状切口的手术进路。