口腔癌颈淋巴清扫术式比较(1)
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2010年1月1日
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【摘要】目的:探讨在口腔癌治疗过程中不同术式的颈淋巴清扫术的预后伤口美观效果。方法:我科对近期数例口腔癌患者进行选择性颈淋巴清扫术或治疗性颈淋巴清扫术。其中大部分手术采用传统“类矩形”切口和“T”型切口,而采用“S”型切口加 颈部“L”型切口的手术3例,采用Macfee平行切口的手术3例。结果:采用“类矩形”切口和“T”型切口的患者颈部瘢痕明显;采用“S”型切口加颈部 “L”型切口的3例患者颈部瘢痕较隐蔽;采用Macfee切口的3例患者颈部瘢痕不明显。结论:在对口腔癌患者行颈淋巴清扫术的过程中采用Macfee平行切口或者“S”型切口加颈部 “L”型切口患者外观影响较小。
【关键词】颈淋巴清扫术;手术切口;颈部瘢痕;美学效应
【中图分类号】R739.8 【文献标识码】B 【文章编号】1008-6455(2010)07-0101-02
Comparison of neck dissection incisions in oral cancer
Xu Junwu Jiang Lei Lin Yi Zheng Song
【Abstract】Objective:To Compire the different aesthetic effectiveness between major surgical methods which is used for the prognosis of neck dissection in oral cancer treatment. Methods:Cases of oral cancer patients have been cured by selective either therapeutic neck dissection,besides 3 treated with “S”-shaped attach neck “L”-shaped incision and 3 treated with Macfee, rest of which were treated with the traditional Yoels incision and modified Crile in our recent division. Results:The patients who used Yoels incision and modified Crile had a obvious cervical scar. 3 patients who used “S”-shaped attach neck “L”-shaped incision had a neck scar private; 3 patients who used Macfee had the neck scar is not obvious. Conclusion:Oral cancer patients who were cured with neck dissection used Macfee or “S”-shaped attach neck “L”-shaped incision will get better aesthetic effectiveness than others.
【Key words】neck dissection; surgical incision; neck scar; aesthetic effectiveness
颈淋巴清扫术是对口腔原发性肿瘤患者进行手术治疗过程中一个重要的组成部分,在头颈部肿瘤的治疗中占有重要地位。自从1906 年Crile 描述颈淋巴清扫术以来,该术式出现了许多改进[1-2]。在临床实践中,传统“类矩形”切口和 “T”型切口为大多数医师采用,但因术后颈部瘢痕明显,而使患者在预后的美学效应较差。我科近年来对颈淋巴清扫术的术式进行改良,分别采用“S”型切口加颈部 “L”型切口和Macfee平行切口对6例口腔癌患者施行了颈淋巴清扫术,效果良好,现报道如下。
1 资料与方法
1.1 临床资料:本组患者均为口腔癌患者,其中采用Macfee平行切口的患者3例,采用“S”型切口加颈部“L”型切口的患者3例,其中舌癌4例、颊癌2例,均经病理证实。患者均为女性,年龄35～52岁,平均年龄44.3岁。
1.2 手术方法
1.2.1 采用Macfee平型切口的颈淋巴清扫术手术方法:手术分五步进行:①在距下颌骨下缘1.5cm处,作一从颏部正中至乳突下方的切口;②在锁骨上1.5cm处,作一从胸骨正中至斜方肌前缘的另一条切口与上述
切口平行;③在颈阔肌下翻瓣,从上切口向下、下切口向上分离皮瓣,形成与两条平行切口等宽的隧道;④将皮瓣下端向上拉起,从下切口开始颈清术,当手术向上分离至上下两切口线中点时,再将皮瓣上端向下牵引,并将颈淋巴清扫物从皮瓣上端引出,继续向上完成颈清术;⑤缝合切口。如图1所示。
1.2.2 采用“S”型切口加颈部 “L”型切口的颈淋巴清扫术手术方法:①在耳屏前作一“S”型切口,绕过耳垂达乳突下方;②在原“S”型切口下端止点继续向垂直下做 “L”型切口,“L”型切口分为纵行切口和水平切口两个部分,纵行切口自“S”型切口下端止点沿斜方肌前缘至锁骨上。水平切口以纵行切口下端止点为起点,沿锁骨上止于胸骨正中处;③在颈阔肌下翻瓣,暴露腮腺下极及颈部创面;④从上至下进行颈淋巴清扫术及口腔癌病灶切除术;⑤用胸大肌皮瓣或者前臂皮瓣修复原口腔癌切除病灶;⑥缝合切口。如图2所示。
1.2.3 采用传统“类矩形”切口及“T”型切口的颈淋巴清扫术手术方法:传统“类矩形”切口及“T”型切口的颈淋巴清扫术的手术方式在教科书上已有详述,这里不再介绍 ......
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