【作者】 马岩；

【导师】 潘新良；

【作者基本信息】 山东大学 ， 耳鼻咽喉科学（专业学位）， 2019， 硕士

【摘要】 [目的]评估颈清扫术中副神经斜方肌支受损对患者术后颈肩功能恢复的影响,研究斜方肌支正确保留在术后肩功能恢复中的作用,为颈清扫术中定位和保护副神经斜方肌支提供参考。[方法]回顾性分析山东大学齐鲁医院耳鼻咽喉科自2017年1月至2018年6月期间因头颈部肿瘤行单侧颈清扫+原发癌切除的病例98例。根据术中清扫范围以及是否对副神经斜方肌支行的单独分离与保护,将病例分为A、B、C三组。A组52例,术中清扫范围为Ⅱ-Ⅳ区,完整保留副神经及其各分支,如胸锁乳突肌支、斜方肌支;B组29例,清扫范围为Ⅱ-Ⅴ区,术中完整保护副神经斜方肌支,保护性分离暴露斜方肌支全长直至神经进入斜方肌前缘,但将胸锁乳突肌支及其它小分支离断;C组17例,因肿大淋巴结侵犯包饶神经,术中离断副神经斜方肌支及胸锁乳突肌支。术后评价斜方肌萎缩程度及患者颈肩功能恢复情况。所有数据用SPSS22.0统计软件处理。术前资料包括年龄、性别、肿瘤原发部位及病理类型。术后肩功能评价包括主观问卷及客观指标,主观感觉问卷调查由患者自行评分(0-10分),结果均为等级资料;肩部活动度测量结果由患者配合医师完成,初步测量结果为数量资料,参考CMS评分将获得的数量资料转化为等级资料后,也采用秩和检验。P<0.05为各个组间差异有统计学意义。[结果]所有98例患者均行单侧颈清扫术+原发癌切除术,手术过程顺利,围手术期无死亡病例。两组病例的术前资料包括年龄、性别、肿瘤原发部位及病理类型,均无统计学差异。术后6月-1年进行关于患者肩功能恢复的随访,A、B两组术后肩功能评价明显优于C组,A、B两组之间肩功能评价无明显差异,年龄对肩功能恢复有明显影响,是否放疗两组的肩功能评分无统计学差异。[结论]颈清扫术后肩综合征的出现,主要和颈清扫术中对副神经斜方肌支的损伤有关,年龄也可以影响肩功能的恢复。在颈侧Ⅱ-Ⅳ区颈清扫术中,因为可以完整保留副神经,所以很少出现肩综合征,对患者术后生活质量影响也很小;在颈后侧Ⅱ-Ⅴ区颈清扫中,如果能正确完整保留副神经斜方肌支,同样可以显著降低肩综合征的发生率,对患者生活质量的影响也较小;而在副神经受损后,术后则会出现明显的肩部疼痛、肩下垂及肩活动度下降等症状,严重影响患者颈清扫术后的生活质量。随着医疗模式的转变,在保证治愈率的同时,人们越来越多的开始注重尽量提高患者的生活质量,在颈清扫术中应尽力保护副神经斜方肌支,努力提高患者术后生存质量。更多还原

【Abstract】 [Objective]To evaluate the effect of trapezius branch of accessory nerve damage in the neck dissection on the recovery of postoperative neck and shoulder function,and study the role of the trapezius branch in the recovery of postoperative shoulder function.Provide a reference for the positioning and protection of the paraspinal muscle branch in the neck dissection.[Methods]We selected 98 head and neck cancer cases which were treated with neck dissection in the Qilu Hospital of Shandong University form January 2017 to June 2018.Based on different surgical methods of descending branch hypoglossal nerve,the patients were divided into three groups(ABC).Group A includes 52 cases with completely preservation of the accessory nerve and its branches such as sternocleidomastoid branch and trapezius branch.Group B consisted of 29 cases,which protected the trapezius branch during operation,but disconnected the sternocleidomastoid branch and other small branches.Group C includes 17 cases with disconnection of the accessory nerve and its branches.Evaluation of trapezius muscle atrophy and recovery of neck and shoulder function in patients were performed from six months to one year after surgery.All data is processed by SPSS22.0.Preoperative data include age,gender,primary tumor location and pathology.Shoulder function evaluation includes subjective questionnaire and objective indicators which are analyzed with Nonparametric Tests.[Results]All 98 patients were performed selective neck dissection and primary cancer resection.The operation was successful and there were no deaths during the perioperative period.By comparing and analyzing the clinical data of the three groups,it can be found that there was no signi:ficant difference between three groups in preoperative general data.The evaluation of postoperative shoulder function in groups A and B was significantly better than that in group C.There was no significant difference in shoulder function evaluation between groups A and B.There was no statistical difference in radiotherapy effects between groups.[Conclusion]The shoulder syndrome after neck dissection is mainly related to the preservation of the trapezius branch of the accessory nerve during the operation.Radiotherapy has little effect on shoulder syndrome.The completely preservation of the accessory nerve can effectively reduce the occurrence of postoperative shoulder syndrome.Only retaining the trapezius branch can also significantly reduce the incidence of shoulder syndrome,even if there is difficulty in turning neck,the impact on the quality of life of patients is also limited.If the trapezius branch of the accessory nerve is damaged,there will be obvious symptoms such as shoulder pain,sagging shoulder and decreased shoulder mobility,and seriously affect the quality of life of patients.So protecting the trapezius branch is very important in neck dissection.更多还原