Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Head Neck. 2011 May;33(5):615-9. doi: 10.1002/hed.21503. Epub 2010 Nov 10.
Shoulder function can be negatively affected during treatment of upper aerodigestive tract carcinoma. The purpose of this study was to investigate the impact of selective neck dissection alone or in combination with radiotherapy and/or chemotherapy.
We conducted an observational study in adults who underwent selective neck dissection for the treatment of upper aerodigestive tract cancer who were >6 months from completion of their therapy. Recurrent disease and use of flap reconstruction were part of the exclusion criteria. A modified Constant's score was used to evaluate shoulder function.
Thirty-four patients (42 selective neck dissections) met the inclusion criterion. Operated shoulder function was significantly (p < .001) decreased as compared to the nonoperated shoulder. There was no statistical difference in the total Constant's score, in the subjective or objective scores among selective neck dissection only, in the selective neck dissection plus radiation therapy, or in the selective neck dissection plus chemoradiation therapy.
Selective neck dissection can have a negative effect on shoulder function despite spinal accessory nerve preservation. Adjuvant therapy does not contribute additional detriment to shoulder function.
在上呼吸消化道癌的治疗过程中，肩部功能可能会受到负面影响。本研究旨在探讨单纯选择性颈部清扫术或联合放疗和/或化疗的影响。
我们对接受选择性颈部清扫术治疗上呼吸消化道癌的成年人进行了一项观察性研究，这些患者在完成治疗后 >6 个月。复发性疾病和使用皮瓣重建是排除标准的一部分。使用改良的 Constant 评分来评估肩部功能。
34 名患者（42 例选择性颈部清扫术）符合纳入标准。与非手术侧相比，手术侧肩部功能明显（p <.001）下降。仅选择性颈部清扫术、选择性颈部清扫术加放疗或选择性颈部清扫术加放化疗之间，总 Constant 评分、主观或客观评分均无统计学差异。
尽管保留了副神经，选择性颈部清扫术仍会对肩部功能产生负面影响。辅助治疗不会对肩部功能造成额外的损害。
