Roh Jong-Lyel, Yoon Yeo-Hoon, Kim Sang Yoon, Park Chan Il
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
Oral Oncol. 2007 May;43(5):491-8. doi: 10.1016/j.oraloncology.2006.05.003. Epub 2006 Sep 18.
Although the practice of neck dissection has greatly advanced from radical to function-preserving surgery, the impact of the sensory nerve-preserving neck surgery on the pain and quality of life (QOL) of patients has received little study. We evaluated neck morbidity and its impact on QOL associated with selective or modified radical neck dissection with or without preservation of cervical root branches. We conducted a retrospective cohort study comparing 24 patients who had their cervical root branches preserved to 29 patients whose root branches were removed during neck dissection. The spinal accessory nerve was preserved and sex, age, pathologic status, side and extent of neck dissection, and radiotherapy were comparable between groups. The groups were compared based on sensory and motor functions of the neck and shoulder and questionnaires on depression and QOL at follow-up of mean 18.7 (range 12-34) months after surgery. The nerve-preserved patients showed a low incidence and severity of neck and shoulder pain compared to the nerve-removed subjects (p<.05). Loss of sensation was more frequently experienced in the nerve-removed group on the earlobe and the lateral neck of the operated side (p<.05). Depression and QOL scores were higher in the nerve-removed group and significantly correlated with pain intensity. Preservation of the cervical root branches reduces postoperative pain as well as permanent anesthetic areas of the neck. This may also improve the mental state and QOL of patients undergoing neck dissection.
尽管颈部清扫术已从根治性手术大幅发展为保留功能的手术，但保留感觉神经的颈部手术对患者疼痛和生活质量（QOL）的影响鲜有研究。我们评估了与保留或不保留颈神经根分支的选择性或改良根治性颈部清扫术相关的颈部发病率及其对生活质量的影响。我们进行了一项回顾性队列研究，比较了24例保留颈神经根分支的患者和29例在颈部清扫术中切除神经根分支的患者。两组均保留了副神经，性别、年龄、病理状态、颈部清扫术的侧别和范围以及放疗情况在两组间具有可比性。根据颈部和肩部的感觉和运动功能以及术后平均18.7（范围12 - 34）个月随访时的抑郁和生活质量问卷对两组进行比较。与切除神经的受试者相比，保留神经的患者颈部和肩部疼痛的发生率和严重程度较低（p<0.05）。切除神经的组在手术侧耳垂和颈部外侧更频繁地出现感觉丧失（p<0.05）。切除神经的组抑郁和生活质量评分更高，且与疼痛强度显著相关。保留颈神经根分支可减轻术后疼痛以及颈部的永久性麻醉区域。这也可能改善接受颈部清扫术患者的精神状态和生活质量。
