neck lymphadenectomy

1. Unexplained lymphadenopathy, or suspected lymph node metastasis, requires histopathological examination to confirm the diagnosis. 2. Isolated lymph node tuberculosis, stable condition, no other active tuberculosis lesions, long-term anti-tuberculosis treatment is ineffective, no adhesions around, no acute infection and ulceration. Treatment of diseases: lymph node tuberculosis, cervical lymph node tuberculosis Indication 1. Unexplained lymphadenopathy, or suspected lymph node metastasis, requires histopathological examination to confirm the diagnosis. 2. Isolated lymph node tuberculosis, stable condition, no other active tuberculosis lesions, long-term anti-tuberculosis treatment is ineffective, no adhesions around, no acute infection and ulceration. Contraindications 1. Residual lesions in the neck or recurrent lesions and deep tissue adhesions in the neck. 2. Patients with distant metastasis or extensive skin infiltration. 3. Old and frail heart, lung, liver and kidney dysfunction can not be corrected. Preoperative preparation 1. Take lymph nodes for pathological examination, detailed physical examination and necessary special examinations; suspected metastatic cancer, should look for the primary lesion. Make a cut mark in advance. 2. For lymph node tuberculosis, anti-tuberculosis drugs should be used for 1 week before surgery. Surgical procedure 1. Position: supine position. The upper body is slightly taller, the back cushion is over, the neck is overstretched, the head is up and turned to the healthy side. 2. Incision: Select according to the lesion. In principle, the direction of the incision should be consistent with the movement of the skin, nerves, and large blood vessels to reduce damage and scar contracture. When the anterior scale paraspinal lymph node is removed, an supraclavicular incision is used. A transverse finger on the clavicle, with the outer edge of the sternocleidomastoid muscle as the midpoint, make a transverse incision of 3 to 4 cm. 3. Resection of the lymph nodes: Cut the platysma and open (or partially cut) the sternocleidomastoid muscle to the midline to identify the scapular scapula. In the upper triangle of the clavicle, the traverse of the neck and the branch of the vein are ligated, and the lymph nodes located in front of the scalene muscle and the brachial plexus are bluntly separated, and the lymph nodes are removed after the ligation and cutting of the small blood vessels entering and leaving the lymph nodes. complication First, wound bleeding: should be judged as general bleeding or large blood vessels have a breach. If there is bleeding in the wound within 24 hours after the operation, he should immediately return to the operating room to stop bleeding. If the common carotid artery is bleeding, it should be sutured in time. Second, cervical nerve injury: vagus nerve, phrenic nerve, hypoglossal nerve, cervical sympathetic nerve, brachial plexus, accessory nerve, etc. are easily damaged in the cleaning process. Mainly because the surgeon is not familiar with the anatomy. The physician should dissect at several key points to identify the nerve, protect the nerve, and perform other cutting operations. After nerve injury, it can be sutured and repaired, but it is difficult to recover. Third, the neck skin splitting or necrosis: There are two reasons for incision necrosis after surgery, one of which: poor design of the incision causes skin ischemia; second, after sufficient chemotherapy. The incision has necrosis to be expanded. It is necessary to change the dressing and clean the wound to facilitate the growth of the granulation. Fourth, elevated intracranial pressure and facial edema: bilateral neck dissection after removal of the internal jugular vein, the head and neck venous return will occur obstacles. Edema on the face, cerebral edema, or even blindness may occur. Treatment is mainly the use of corticosteroids or intermittent use of diuretic drugs. As time goes by, edema will improve to some extent. Preventive measures include avoiding bilateral neck dissection. V. Pneumothorax: Rarely, mainly because the gas enters the mediastinum from the neck. When the mediastinal gas is too much, it can enter the chest through the mediastinum pleura. Another rare reason is that the anterior or posterior margin of the anterior scalene muscle is too deep, which directly damages the pleural apex and causes pneumothorax. It mainly occurs in emphysema patients or thin patients, and the position of the parietal pleural apex rises above the clavicle. After the discovery, the anesthesiologist should inflate the lungs, increase the pressure in the chest, discharge the gas in the chest, and suture the soft tissue around the top of the pleura. At the end of the operation, if there is still a lot of gas in the chest, chest drainage is performed between the second front ribs. Sixth, chyle leakage: chest tube injury is caused by rupture of lymphatic vessels during operation of the upper part of the clavicle. Should return to the operating room to open the wound, chest catheter ligation, it is best to use a local transfer muscle flap to cover the cervical thoracic duct injury.