【摘要】 目的:本研究对颈清扫术后颈部疼痛的发生及其对生活、工作的影响进行较全面的了解,并提出相应的解决办法。方法:对50例患者,54侧根治性颈清扫术(RND)通过主观评价和客观检查了解颈清扫术后颈部疼痛的发生部位、程度及其相关因素,并对另外34例RND采取以下对策:(1)颈丛C2~C4切断后,残端外膜保留0.5 cm,将外膜包裹神经断端并缝合,再将该神经残端埋入邻近肌纤维内,以避免神经瘤的产生;(2)在颈清扫术中保留颈丛斜方肌分支或采用颈丛肩胛提肌支与副神经移位吻合以减轻肩综合征的发生,改善因斜方肌瘫痪失去悬吊肩的功能而造成的臂丛和肩周其它肌肉牵拉和过度紧张产生的疼痛。结果:54侧RND中,24.07%可触及颈部疼痛敏感点甚至神经瘤。颈部及肩部疼痛,视觉摸拟评分法(VAS)评价平均为2.62分,放疗无明显加重术侧肩部疼痛的作用。通过对颈清扫术式的上述改良可杜绝神经瘤的形成和明显减弱肩综合征造成的颈部及肩部的疼痛。结论:传统根治性颈清扫术后颈部疼痛对患者生活和工作有较大妨碍,通过对颈清扫术式的适当改良可明显减少神经瘤的产生和肩综合征的发生,减轻疼痛,改善患者的生存质量。更多还原

【Abstract】 Objective: To survey the pain after neck dissection and its effect on quality of social life,and advocate some options to solve the postoperative pain.Methods: 50 patients,54 sides neck dissection were evaluated for neck pain.The location,extent and some influence factors of pain were investigated.Additionally,34 cases RND were designed as follows in order to release the neck pain:(1) retaining epinurium 0.5 cm after C2～C4 being cut,then suturing epinurium and implanting it into fibers of muscle to avoid the formation of neuromas;(2) Preserving branches of C3,C4 to trapezius muscle or transposition anastomosis of the branches of cervical plexus to levator scapulae with the accessory nerve during neck dissection to reduc pain resulting from shoulder syndrome.Results: Of the 54 sides RND,24.07% were found obvious pain-trigger even neuromas in the neck.The average of VAS of pain coming from neck and shoulder was 2.62,no apparent evidence was found that irradiation had any effect on pain in the neck.Two options as mentioned above for modifying the traditional radical neck dissection had great advantage in reducing pain either from neuromas or shoulder syndrome.Conclusions: Pain localized to the operative neck and the shoulder region was a common occurrence after traditional RND and caused variable degree of pain that influenced patient’s life quality directly,whereas modified neck dissection was usually a painless procedure and improved patient’s life quality efficiently.更多还原