Mishra Abhijeet Kumar, Parida Pradipta Kumar, Bhoi Sanjeev Kumar, Sahoo Jagannath, Samal Dillip Kumar, Dash Ashish, Mittal Yash, Chithambaram Kalyana Sundaram, Swarup Anurita, Chenniappan Swathi, Anwer Shah P A
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India.
Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3245-3255. doi: 10.1007/s12070-024-04659-y. Epub 2024 Apr 9.
Head and neck cancers are fairly common in India due to the widespread consumption of tobacco and neck dissection is a major component in the surgical management. The objective of this study is to analyze the effect of MRND and SND on shoulder function and quality of life in patients of head and neck cancer. Our study is a prospective comparative study on 65 head and neck cancer patients divided into 2 groups-33 in group A (MRND group) and 32 in group B (SND group). Clinical evaluation of shoulder function was done pre-operatively, 1 week, 1 month, 3 month and 6 month post-operatively using arm abduction scores (AAS) and shoulder pain and disability index (SPADI). Nerve-conduction study (NCS) was done pre-operatively and 3 months post-operatively for assessment of SAN. Neck dissection quality of life questionnaire (NDQOL) was used as a quality-of-life measure. A total of 65 neck dissections were included in the analysis (33 in group A and 32 in group B) out of which 53 were males and 12 were females. The mean AAS on the 6th post-operative month in group A was significantly lower than that of group B ( = 0.01). The mean SPADI scores on the 6th post-operative month was significantly worse in group A than group B ( value 0.01). On NCS, a significant decrease in amplitude was seen in group A ( = 0.02) and a significant increase in latency was noted in group B ( = 0.005). Quality of life score on 6th post-operative month showed no significant difference between both the groups ( > 0.05). Level V dissection in MRND is associated with higher incidence and greater severity of shoulder dysfunction. AAS and SPADI score are useful tools in post operative follow up of shoulder dysfunction. NCS helps in the detection of neuropathy and to determine its severity. Early rehabilitation promotes long term recovery.
由于烟草的广泛消费，头颈癌在印度相当常见，而颈部解剖是外科治疗的主要组成部分。本研究的目的是分析改良根治性颈清扫术（MRND）和选择性颈清扫术（SND）对头颈癌患者肩部功能和生活质量的影响。我们的研究是一项前瞻性比较研究，对65名头颈癌患者进行分组，A组（MRND组）33例，B组（SND组）32例。术前、术后1周、1个月、3个月和6个月使用手臂外展评分（AAS）和肩部疼痛与功能障碍指数（SPADI）对肩部功能进行临床评估。术前和术后3个月进行神经传导研究（NCS）以评估副神经（SAN）。颈部解剖生活质量问卷（NDQOL）用作生活质量衡量指标。分析共纳入65例颈部解剖病例（A组33例，B组32例），其中男性53例，女性12例。A组术后第6个月的平均AAS显著低于B组（P = 0.01）。A组术后第6个月的平均SPADI评分显著差于B组（P值0.01）。在NCS方面，A组振幅显著降低（P = 0.02），B组潜伏期显著增加（P = 0.005）。术后第6个月的生活质量评分在两组之间无显著差异（P>0.05）。MRND中的V级解剖与肩部功能障碍的更高发生率和更严重程度相关。AAS和SPADI评分是肩部功能障碍术后随访的有用工具。NCS有助于检测神经病变并确定其严重程度。早期康复促进长期恢复。
