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颈部淋巴结清扫术后的神经血管并发症:印度南部一家三级医疗中心的前瞻性分析

Neurovascular Complications After Neck Dissection: a Prospective Analysis at a Tertiary Care Centre in South India.

作者信息

Sharma Nivedita, George Nebu Abraham, Sebastian Paul

机构信息

Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala India.

Present Address: Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India.

出版信息

Indian J Surg Oncol. 2020 Dec;11(4):746-751. doi: 10.1007/s13193-020-01229-w. Epub 2020 Sep 26.

Abstract

Owing to high incidence of oral cancers in India, neck dissection is the most commonly performed procedure in any head and neck oncology setup. This surgery is particularly prone to various neurovascular complications due to intricate anatomy of neck, but the exact incidence has been studied less especially in Indian subcontinent. A prospective observational study was done on 105 patients of oral cancer who underwent neck dissection at Regional Cancer Centre, Trivandrum, and various short-term and long-term neurovascular complications were recorded. There was high temporary praxia of marginal mandibular and greater auricular nerve of 32.5% and 36.1%, respectively, immediate post-operative period which reduced significantly during 6 months. Eight patients had long-term shoulder abduction difficulty. There were isolated cases of IJV thrombosis and phrenic nerve paralysis. Despite our best intentions, complications arise due to complex anatomy of the neck, but if surgeon remains cognisant of the potential complications, their impact on patients' health, pocket and hospital resources can be minimized.

摘要

由于印度口腔癌的高发病率,颈部清扫术是任何头颈肿瘤治疗机构中最常进行的手术。由于颈部解剖结构复杂,该手术特别容易出现各种神经血管并发症,但确切的发病率研究较少,尤其是在印度次大陆。对在特里凡得琅地区癌症中心接受颈部清扫术的105例口腔癌患者进行了一项前瞻性观察研究,并记录了各种短期和长期神经血管并发症。术后即刻,下颌缘支和耳大神经的暂时性麻痹发生率分别高达32.5%和36.1%,在6个月内显著降低。8例患者存在长期肩部外展困难。有孤立的颈内静脉血栓形成和膈神经麻痹病例。尽管我们尽了最大努力,但由于颈部解剖结构复杂,并发症仍然会出现,但如果外科医生意识到潜在的并发症,它们对患者健康、经济和医院资源的影响可以降到最低。

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本文引用的文献

1
Anatomic variations of the marginal mandibular nerve.下颌缘支神经的解剖变异
Indian J Surg Oncol. 2012 Mar;3(1):8-11. doi: 10.1007/s13193-011-0121-3. Epub 2012 Jan 10.
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Neck treatment and shoulder morbidity: still a challenge.颈部治疗与肩痛并发症:仍是挑战。
Head Neck. 2011 Jul;33(7):1060-7. doi: 10.1002/hed.21495. Epub 2010 Oct 19.
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Prevention of complications in neck dissection.颈部清扫术中并发症的预防
Head Neck Oncol. 2009 Oct 12;1:35. doi: 10.1186/1758-3284-1-35.
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Quality of life after neck dissection.颈部清扫术后的生活质量。
Arch Otolaryngol Head Neck Surg. 2006 Jun;132(6):662-6. doi: 10.1001/archotol.132.6.662.
9
Shoulder complaints after nerve sparing neck dissections.保留神经的颈部清扫术后的肩部问题
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