Brandenburg J H, Lee C Y
Laryngoscope. 1981 Nov;91(11):1851-9. doi: 10.1288/00005537-198111000-00009.
The greatest morbidity associated with the radical neck dissection has been the "shoulder syndrome" due to the sacrifice of the spinal accessory nerve. Despite the fact that the XIth nerve can be spared by a careful dissection of the postcervical triangle, to do so remains a controversial issue. The 125 radical neck dissections performed at the University of Wisconsin Clinical Science Center from 1970 through 1975 were carefully evaluated to determine the incidence of recurrent tumor in the operated-on neck. In 60 cases the spinal accessory nerve was resected with the neck specimen, and in 65 cases the nerve was preserved. A second study was then undertaken involving 245 neck dissections performed from 1975-1978 in the Wisconsin Head and neck Cancer Control Network Hospitals. In 69 instances the spinal accessory nerve was spared. The total number of neck dissections (370 cases) from both studies were analyzed. The overall rate for recurrent tumor in the neck with the classical neck dissection was 12%. When the spinal accessory nerve was spared, the recurrent rate was 6%. On the basis of these observations we propose that the classical neck dissection can be modified to preserve the spinal accessory nerve without jeopardizing the chances for a cure in elective neck dissections and selected therapeutic neck dissections.
与根治性颈清扫术相关的最大发病率是由于副神经被切断而导致的“肩部综合征”。尽管通过仔细解剖颈后三角可以保留第XI对神经，但这样做仍然是一个有争议的问题。对1970年至1975年在威斯康星大学临床科学中心进行的125例根治性颈清扫术进行了仔细评估，以确定手术侧颈部复发肿瘤的发生率。在60例病例中，副神经与颈部标本一起被切除，在65例病例中，神经得以保留。然后进行了第二项研究，涉及1975年至1978年在威斯康星头颈癌控制网络医院进行的245例颈清扫术。在69例病例中，副神经得以保留。对两项研究中的颈清扫术总数（370例）进行了分析。经典颈清扫术的颈部复发肿瘤总体发生率为12%。当副神经得以保留时，复发率为6%。基于这些观察结果，我们建议可以对经典颈清扫术进行改良，以保留副神经，而不会在选择性颈清扫术和某些治疗性颈清扫术中危及治愈的机会。
