颈廓清术

颈廓清术(neck dissection)．国内的名称较多，如颈淋巴结清除术、颈淋巴清扫术、颈部大块廓清术、颈清扫术、颈清术等。此手术的目的在于清除一侧或两侧的颈部淋巴组织，以治疗头颈部恶性肿瘤颈部的转移。     

阿托品治疗颈淋巴结清扫术后并发颈淋巴漏

采用阿托品肌注并局部加压包扎法治愈１８例头颈部肿瘤切除及颈淋巴清扫术后并发颈淋巴漏患者，并与单纯用局部加压包扎法治疗的８例同种患者进行对照，前者较后者治疗时间平均缩短７ｄ，两组有显著差异（Ｐ〈０．０１）。表明阿托品肌注并局部加夺包扎法能在短期内控制颈淋巴漏。因此，有较好的临床应用价值。     

颈廓清术的几点改进

目的：探讨颈廓清手术的方法以提高治疗效果,方法：于６５例头颈肿瘤患者行颈廓清术时,对切口,探查入路及手术操作作了部分改进。结果：６５例颈廓清术时间炙１１０ｍｉｎ,术中出血量平均为１２０ｍｌ,手术并发症发生率降至１．５４％,术后２年生存率为８６．２％,３年生存率为８１．６％。     

头颈肿瘤病人颈廓清术进展

近年来头颈外科十分重视在切除肿瘤的同时提高病人的生存质量,微创手术的开展也倍受关注,其中颈廓清术的临床研究越来越深入,在术式选择的观念上,又有新的进展。现就有关淋巴解剖区域划分,颈廓清术的分类和适应证的选择等进行综述。     

头颈部恶性肿瘤颈淋巴转移的治疗方案和手术命名 (2004年,大连)

2004年7月在大连全国颈部淋巴结转移病变处理策略研讨会就颈淋巴转移的治疗问题，会前在全国征集了建议，在会上进行了广泛讨论，会后汇集成文后，又根据一些同道的补充意见做了修改，形成这一方案，以图提高颈淋巴转移的治疗水平。     

003喉癌和下咽癌选择性颈淋巴清扫术

喉及下咽鳞癌易于颈淋巴结转移，局限于此主要取决于原发病灶的部位。颈淋巴结的五个解剖区域引坤定义出标准化颈淋巴结群的转移扩散危险性，I区包括颏下及颌下三角。该复习资料考虑到这些三角在颈清扫中的作用，除非有明确扩散证据，包括I区的颈清扫是多余的，因为该区淋巴结并不真有转移危险，因此，SLND在喉及下咽鳞癌中起重要作用。     

颈清扫术的变革与循证医学

循证医学要求用无可辩驳的科研实证来提高医疗质量。循证医学的本质，用一句俗话，就是“拿证据说话”。记得在一次全国性头颈外科会议上，讨论对临床N0(clinical N0，cN0)病变的处理时，有些医师反对对cN0病例一律做颈清扫术，一位有经验的医师说：“现在颈清扫术手术很安全，患者又愿意做，为什么不做?”有另一位头颈外科医师立刻提出：“拿证据来!”由于没有确凿的证据、     

颈廓清术后并发乳糜漏的非手术治疗

颈廓清术是头颈部癌的主要外科治疗手段，乳糜漏或右侧淋巴导管漏是颈廓清术中虽不常见但较为严重的并发症，文献报道发生率仅为1．0%～2．5％，如果处理不当，可导致乳糜液积聚，引起局部皮瓣漂浮、坏死；造成颈部动脉暴露发生致死性大出血，也可造成咽漏或口腔皮肤漏；     

舌癌的择区性颈清扫术

舌游动部分鳞状细胞癌较易发生颈淋巴转移，据报道约有30％的初诊病例临床检查即可发现转移的肿大淋巴结。虽然如此，但也有不少病例，即使是晚期的T4病变，临床检查也未触及肿大淋巴结(cNO)。触及肿大淋巴结做传统的或功能性的颈淋巴清除当无异议，但对cNO病例的治疗处理仍有不同意见。     

声门上型喉癌颈淋巴隐匿性转移及其处理

目的 探讨声门上型喉癌颈淋巴隐匿性转移规律及其处理方法。方法 选择术前未行放疗、化疗的声门上喉鳞状细胞癌，临床N0M0病例，共30例，男19例，女11例；年龄40～72岁，平均54．8岁；按UICC(1997年)标准分期1、28例，1318例，T44例。行主病变侧肩胛舌骨肌上颈清扫术(supraomohyoid neck dissecton，SOHND)，将获得淋巴结逐一行病理组织学检查，观察其转移规律及临床治疗效果。结果 首次颈清扫术30例中有6例颈淋巴结转移癌阳性，在2～3年随访中有3例发生对侧颈淋巴结转移，计有9例颈淋巴转移，隐匿性转移率同侧为20％(6／30)，对侧为10％(3／30)。颈清扫术共获淋巴结527个，平均每侧17．6个。获转移阳性淋巴结10个，其中Ⅱ区9个，Ⅲ区1个，Ⅰ区无癌转移。喉及主病变侧颈部均无复发，2年无瘤生存率86．7％(26／30)。结论 声门上型喉癌颈淋巴结隐匿性转移率达30％，采用Ⅱ、Ⅲ区的择区性颈清扫术处理其颈淋巴结(Ⅰ区可不必作为常规清扫区域)是切实可行的。     

Three cases of bilateral chylothorax developing after neck dissection

Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.     

同期双侧颈清扫在头颈部恶性肿瘤治疗中的应用

目的:探讨头颈部恶性肿瘤行原发灶切除加同期双侧颈清扫的安全性、适应证及手术难点.方法:回顾分析1998-01-2007-12间134例行肿瘤原发灶切除加双侧颈清扫术头颈部恶性肿瘤患者的临床资料,同期双侧颈清扫术方式分为:一侧根治性颈清扫加一侧功能性颈清扫(29例),一侧根治性颈清扫加一侧侧颈清扫(34例),双侧功能性颈清扫(14例),一侧功能性颈清扫例加一侧侧颈清扫(48例), 双侧颈侧清扫6例.结果:134例患者无一例手术死亡,并发症为创口出血3例,乳糜漏4例,咽瘘8例,咽瘘伴颈部清扫区感染1例,消化道应激性溃疡5例,其中1例抢救无效死亡,脑梗塞1例.结论:头颈部恶性肿瘤行同期双侧颈清扫是安全的,但要选择适当的清扫方式,以降低颈部淋巴结转移,减轻患者痛苦.     

Ischaemic optic neuropathy following bilateral neck dissection

Two cases of ischaemic optic neuropathy, which occurred as a complication of oncological neck surgery, are reported. These cases are submitted because of the apparent scarcity in the literature of this complication after head and neck surgery. They are also unusual because they presented with different clinical manifestations of ischaemic optic neuropathy after separate forms of bilateral neck dissection. A literature review identifies a small number of similar cases and risk factors and preventative measures are discussed.     

Planned postradiotherapy bilateral neck dissection for head and neck cancer

Purpose: This is a retrospective analysis of 50 patients with squamous cell carcinoma of the head and neck treated with radiotherapy (RT) to the primary site and bilateral neck followed by a planned bilateral neck dissection approximately 4 to 6 weeks after completion of RT.Patients and Methods: Between November 1964 and March 1997, 50 patients underwent bilateral neck dissections after RT, with minimum 2-year follow-up. Forty-eight patients had bilateral positive neck nodes.Results: At 5 years, the rates of neck disease control, local-regional control, and cause-specific survival were 76%, 70%, and 39%, respectively. Five severe complications developed after surgery, and 1 developed after RT.Conclusions: Radiotherapy followed by a planned bilateral neck dissection resulted in a high rate of local-regional control with acceptable morbidity. The likelihood of severe complications after simultaneous (as opposed to staged) neck dissection was not significantly different (P = .24). (Am J Otolaryngol 2001;22:383-386.     

喉癌患者同时双颈廓清术临床分析

为了提高喉癌患者的生存率，正确开展双颈廓清术，减少手术并发症，对５４例同时行双颈廓清术的喉癌患者的临床资料进行分析。结果表明，在尽可能保留一侧颈静脉的情况下，双颈廓清术是安全的，并发症不重。本组３年和５年生存率分别为６２％（３０／４８）和５２％（１９／３６）。死亡的主要原因是颈淋巴结癌复发和肿瘤局部复发，这和本组大多数为晚期癌有关。作者主张，对晚期声门上癌，如决定行廓清手术，最好同时行双颈廓清术，并尽可能行功能性廓清或保留颈内静脉的廓清     

The problem of unilateral and bilateral neck dissection.

270 unilateral and bilateral neck resections have been performed in different primary localisations of tumours in the head and the neck at the Ear, Nose and Throat Department of the Medical Faculty in Zagreb in the period 1960-70. Of 209 patients with unilateral resection, only 78 survived (37%), while only 3 patients (4.9%) survived of a total of 61 patients where bilateral resection was performed. An analysis is given separately of radical resection in carcinoma of the larynx, the hypopharynx and the skin. From this analysis and from immunologic considerations, the following conclusions are derived: (i) The authors are not in favour of prophylactic block resection as this would be contrary to our knowledge of the role played by the immunobiological factors in the struggle against the malignant lesion. (ii) Evacuation of the neck must be performed in carcinoma of the larynx T3 and in hypopharyngeal carcinoma, as histologically positive lymph nodes are usually found in this site in large numbers.     

声门上型喉癌患者两期双侧颈淋巴结清扫术的疗效比较

目的 :总结双侧颈淋巴结清扫术在处理声门上型喉癌颈部淋巴结转移癌中的临床意义。方法 :对76例声门上型喉癌患者在切除原发灶同时 ,将术前诊断双侧颈淋巴结转移的 33例进行同期双侧颈清扫术 (同期清扫组 ) ;一侧颈部淋巴结转移的 43例行一侧颈清扫术 ,随诊中发现对侧转移再行 2期对侧颈清扫术 (分期清扫组 )。结果 :同期清扫组 3年生存率为 81.5 % (2 2 / 2 7) ,5年生存率 6 1.5 % (16 / 2 6 ) ;1例术后当天死于脑压增高。分期清扫组 3年生存率为 6 9.2 % (2 7/ 39) ,5年生存率 2 7.8% (10 / 36 ) ;1例术后当天呼吸道梗阻死亡。结论 :声门上型喉癌双侧颈转移淋巴结同期清扫术 ,比双侧分期清扫术期能明显提高患者的生存率。术中尽可能保留双侧颈内静脉 ,必要时行血管吻合重建颈内静脉 ,能减少术后的并发症。     

Blindness: a potential complication of bilateral neck dissection

Permanent blindness, is a very rare, but devastating complication of simultaneous bilateral neck dissection. Most otolaryngologists/head and neck surgeons are unaware that amaurosis can result from this surgery, and this paper is meant as a poignant reminder of that end. A case report is presented, followed by a discussion of possible aetiology; a management protocol is proposed.     

喉癌患者同时双颈廓清术临床分析

为了提高喉癌患者的生存率，正确开展双颈廓清术，减少手术并发症，对５４例同时行双颈廓清术的喉癌患者的临床资料进行分析。结果表明，在尽可能保留一侧颈静脉的情况下，双颈廓清术是安全的，并发症不重。本组３年和５年生存率分别为６２％（３０／４８）和５２％（１９／３６）。死亡的主要原因是颈淋巴结瘤复发和肿瘤局部复发，这和本组大多数为晚期癌有关。作者主张，对晚期声门上癌，如决定行廓清手术，最好同时行双颈廓清术，     

Amaurosis: a complication of bilateral radical neck dissection.

Blindness is a devastating complication of bilateral radical neck dissection. To our knowledge, it has been reported in the literature only 12 times. Although the cause is still controversial, many common factors have been identified. We present a case of blindness after bilateral neck dissection and discuss the perioperative circumstances and the possible causes. We also compare and contrast other cases described in the literature and suggest methods in which this complication can be prevented.