| Background and ObjectiveNeck dissection played an important role in treating, from the 1950's, the applying of radical neck dissection (RND) increased the treatment results of patients suffered from craniofacial squamous cell carcinomas obviously. But there are some problems in performing the traditional RND. The internal jugular vein (IJV) was first blocked from the upper side, and caused swelling of residual IJV. It was difficult to separate the swelling vein and lead to haemorrhage in operation. In 1960's, based on the anatomical research, some modifications was made on RND. In order to improve the patients' lives quantity, researchers worldwide have been trying to improve and modify the operating program. Consequently, our study plans to investigate the effect of reverse neck dissection on thetreatment of craniofacial squamous cell carcinomas. We also arranged to test whether it can make anatomy easier, less bleeding and not influence the excise rate of the lymph node.MethodsThe study was conducted on 61 patients with squamous cell carcinoma of oral mucosa , adopted to our hospital from 1999 to 2003. The pathological TNM stage was Ti^N^Mo. The series comprised 38 males and 23 females. The maen age was 48.4 (range 31-72 years). The primary tumors were divided into 6 groups: gingival (12 patients) , plate (10 patients), buccal mucosa (6 patients), floor of mouth (5 patients), oral-pharynx (4 patients) and lip (3 patients). All the patients were underwent primary radical surgery and simultaneous neck dissection. A total of 15 patients were managed by reversed neck dissection, and 46 were underwent traditional neck dissection. All the excision samples were taken pathological examination. The diagnosis were made according to the recommendations of UICC.The patients were divided into two series by the rule: 61 unanimous cards were made, 15 were printed "multi function", 46 were printed "routine", the surgeon choose the card by double blind method, according to the card , decided the method of operation.In operation, we recorded the operation time, haemorrhage volume,and blood pressure transformation. All the patients were followed every 3 months, and questionable lymph node were taken biopsy and pathological examination to determine its recurrence. At last, statically analysis was made to compare the different operation mode.Furthermore,8 healthy rabbit were divided into 2 groups. Group 1 block the internal jugular vein at the upper side; Group 2 block the internal jugular vein at the lower side. Intracranial pressure was measured in our test.ResultsThe haemorrhage volume of study group ranged 150-200ml, the mean amount was 185ml; the amount of contrast were 190-235ml and 250ml and there was significant difference (p<0.01). The blood pressure transformation in study group was 15-20mmHg/5-10 mmHg, in comparison group was 16-19mmHg/7-10 mmHg and there was no statically meaning (p>0.05). The average time of operation was 70min and 90min respectively, the difference has obvious statically meaning (p<0.01). All the 61 patients had lymph node metastasis. Followed by 12-24 months, 4 patients (4/46) were confirmed recurrence on neck lymph node, and they were all came from the comparison group, and there was no statically meaning (p>0.05).All increased after blocking the IJV in rabbit, but there was no statically meaning (p>0.05).Conclusion1. Reverse neck dissection can make the operation more simplicity and decrease the haemorrhage volume.2. Reverse neck dissection does not increase the recurrence rate of neck lymph node.3. Reverse neck dissection will not affect the intracranial pressure in and after operation either.4. Reverse neck dissection can exposure the access nerve easier.In a word, reverse neck dissection has great value in clinical apply.
|
PDF Full Text Request