頸部郭清の合併症の発生率と臨床的分析

Incidence and Clinical Analysis of Complications of Neck Dissection.

抄録

本研究の目的は、頸部郭清の種類に関連する合併症の発生率を様々な変数に評価し、評価することである。2010年から2019年の間に当院の頭蓋顔面センターに報告し、頸部郭清を受けた患者を対象にレトロスペクティブ研究を実施し、頸部郭清に関連する合併症の評価を行った。全患者の記録を術中合併症、術直後合併症（10日以内）、術後合併症に分けて分析した。扁平上皮癌の手術を受けた256例（25〜70歳の男性141例、女性115例）が対象となった。全体の合併症発生率は32.8％であった。術中合併症は出血14％、神経損傷5.4％、不注意による内頸静脈結紮0.3％、胆汁漏出0.3％であった。頸動脈ブローアウトはなかった。術直後の合併症は血腫形成7％、唾液瘻2.3％、再手術1.5％であった。術後合併症は創部剥離22.6％、感染20.7％、血腫2.7％、唾液瘻11.7％、神経損傷0.3％であった。頸部郭清は難易度の高い治療法である。頸動脈ブローアウト、腕神経叢、迷走神経、舌下神経の損傷などの重大な合併症の予防には、頸部の解剖学的知識を十分に身につける必要がある。

The aim of the study was to assess and evaluate the incidence of complications related to type of neck dissection to different variables. Retrospective study was conducted on patients who reported to our craniofacial centre between 2010 and 2019 and underwent neck dissection for evaluation of complications related to it. Records of all patients were analysed for complications which were alienated into intra-operative, immediate post-operative (within 10 days) and post-operative complications. 256 patients, 141 male and 115 female aged between 25 and 70 years operated for squamous cell carcinoma were included. The overall incidence of complications was 32.8%. Intra-operative complications were haemorrhage 14%, nerve injury 5.4%, inadvertent internal jugular vein ligation 0.3%, chyle leak 0.3%. No incidence of carotid blow out. Immediate post-operative complications were hematoma formation 7%, salivary fistula in 2.3% and re-exploration was done in 1.5% cases. Post-operative complications noted were wound dehiscence in 22.6%, infection in 20.7%, hematoma in 2.7%, salivary fistula in 11.7% and nerve injury in 0.3% cases. Neck dissection is a challenging and therapeutic procedure. Prevention of major complications like carotid blow-out, injury to brachial plexus, vagus nerve or hypoglossal nerve requires thorough knowledge of neck anatomy.