【作者】 童磊；

【导师】 翦新春；

【作者基本信息】 中南大学 ， 口腔临床医学， 2011， 硕士

【摘要】 目的比较单侧颈淋巴结清扫术颈部改良曲线切口与经典切口对患者术后颈部功能和美学的影响,旨在探讨一种能最大限度提高患者术后生活质量的理想切口,为颌面外科医师颈淋巴结清扫术颈部切口的选择提供理论依据。方法回访口腔颌面部恶性肿瘤行单侧颈清扫术术后6个月以上至中南大学湘雅医院口腔科复查就诊的患者20例,改良曲线切口和类矩型切口各10例,测量其面颈部皮肤感觉丧失、异常性疼痛、瘢痕及颈部运动度。感觉丧失测量8个区域：耳下区、面中份、面下份、颈后上份、颈前外侧上份、颈后下份、颈前上份、颈前下份；异常性疼痛测量颈部和颊部的皮肤；瘢痕的评价采用温哥华量表,包括瘢痕的色泽、厚度、血管分布和柔软度四项指标,每项指标对应相应的分数,总得分越高,就代表瘢痕越严重；颈部运动度包括：颈部向健侧侧屈角度,向患侧侧屈角度,向健侧转动角度,向患侧转动角度,前屈角度、后仰角度。所得数据进行相应的LSD-t检验和X2检验。结果1、改良曲线切口颈部皮肤感觉丧失的有5例,感觉丧失区域集中在A、D、E、F区域,即耳下区、颈后上份、颈前外侧上份、颈后下份区域,异常性疼痛的有0例；类矩型切口颈部皮肤感觉丧失的有6例,感觉丧失区域同样集中在A、D、E、F区域,异常性疼痛的有0例。差异无统计学意义(P>0.05)。2、瘢痕结果采用均值±标准差表示,颈部改良曲线切口为3.30±1.42,类矩型切口为6.00±2.67,差异有统计学意义(P<0.05)3、颈部运动度采用均值±标准差表示。颈部改良曲线切口的向健侧侧屈角度23.32±2.87°,向患侧侧屈角度26.36±2.11°,向健侧转动角度61.29±6.69°,向患侧转动角度66.74±8.52°,前屈角度45.59±12.57°,后仰角度38.27±3.06。；类矩型切口向健侧侧屈角度20.86±8.22°,向患侧侧屈角度24.37±7.84°,向健侧转动角度51.11±10.00。,向患侧转动角度64.76±9.89°,前屈角度43.55±13.53。,后仰角度33.62±5.69。。两种切口向健侧旋转和后仰的角度比较P<0.05,有统计学意义；余颈部运动角度比较P<0.05,无统计学意义。结论1、改良曲线切口和类矩型切口对患者术后颈部皮肤的感觉影响无明显差异,其A耳下区、D颈后上份、E颈前外侧上份、F颈后下份区域感觉丧失明显；两种切口均无异常性疼痛2、改良曲线切口产生的颈部瘢痕较轻,较类矩型切口具有更好的美学效应。3、改良曲线切口患者颈部活动度较类矩型患者为好。更多还原

【Abstract】 Objective By comparing the influence of adopting modified curve incision and conventional incision on neck function and aesthetics after unilateral neck dissection, we try to seek an ideal incision maximizing patients’quality of life after operations and to provide maxillofacial surgeons with theoretical evidences on choosing incisions in neck dissection.Methods Twenty return visit patients with maxillofacial malignant tumor to the department of stomatology, Xiangya Hospital, Central South University 6 months or more after unilateral neck dissection were selected,10 of which underwent modified curve incision and the other were of quasi-rectangular incision. Sensation loss, allodynia, scar and motion of faciocervical region were examined. Eight regions including lower ear, middle face, lower face, upper posterior neck, upper anterolateral neck, lower posterior neck, upper anterior neck and lower anterior neck regions. Skin of neck and bucca was examined to judge allodynia. To evaluate scar, Vancouver scar scale (VSS) was adopted, which includes 4 parameters--color, thickness, distribution of vessels and tenderness. To assess cervical motion, angles of laterofalexion and rotation to both unaffected and affected sides, anteflexion and extension were observed. Data collected were statistically analyzed.Results 1. Modified curve incision had 5 cases with sensation loss of cervical skin, the area concentrated in A.,D,E,F, while had 0 case of allodynia.; Quasi-rectangular incision had 6 cases with sensation loss of cervical skin, the area concentrated in A.,D,E,F, while had 0 case of allodynia. The variance was not statistically significant(P<0.05).2. Results of scar were expressed as means±SD.The mean value of scar was 3.30±1.42 in modified curve incision, the mean value of scar was 6.00±2.67 in quasi-rectangular incision. The variance was statistically significant(P<0.05).3. Results of the motion of the neck were also expressed as means±SD. The mean value of lateral flexion away from operated side was 23.32±2.87°in modified curve incision and 20.86±8.22°in quasi-rectangular incision. The mean value of lateral flexion to operated side was 26.36±2.11°in modified curve incision and 24.37±7.84°in quasi-rectangular incision. The mean value of rotation away from operated side was 61.29±6.69°in modified curve incision and 51.11±10.00°in quasi-rectangular incision. The mean value of rotation to operated side was 66.74±8.52°in modified curve incision and 64.76±9.89°in quasi-rectangular incision. The mean value of forward flexion was 45.59±12.57°in modified curve incision and 43.55±13.53 in quasi-rectangular incision. The mean value of extension was 38.27±3.06°in modified curve incision and 33.62±5.69°in quasi-rectangular incision. The items, including rotation away from operated side and extension were statistically significant(P<0.05), while others were not statistically significant(P>0.05).Conclusion 1. The sensation of the neck skin had no obvious difference between modified curve incision and quasi-rectangular incision. The loss of sensation was concentrated in A, D, E, F area.2. Modified curve incision resulted in less obvious scar and better aesthetic effects.3. Modified curve incision resulted in greater cervical motion.更多还原