neck lymphadenectomy

A cancer that originates in the ear, nose, and throat, and a radical resection in the presence of cervical lymph node metastasis. The purpose of the operation is to remove the lymph nodes of the neck, under the armpit, the anterior neck, the neck, and the neck. For this reason, the upper edge of the mandible must be descended, down to the clavicle, from the midline of the neck, and then to the oblique side. This area of the muscle includes the sternocleidomastoid muscle, the scapularis muscle, the second abdominal muscle, the internal jugular vein, the accessory nerve, and the submandibular gland, and is removed together with the lymph nodes. For smaller, limited cervical metastatic lymph nodes, functional cervical lymphadenectomy may be used. Prophylactic cervical lymph node resection is feasible for suspicious cervical lymph node metastasis. Treatment of diseases: laryngeal cancer Indication 1. The ear, nose and throat cancer has cervical lymphadenopathy, hard, active, clinical diagnosis of cervical lymph node metastasis (or suspicious metastasis), and the primary site cancer has been controlled or estimated to be controlled. Possible radical cervical lymph node resection. 2. The cervical lymph nodes are obviously swollen, hard and difficult to promote, and the clinical diagnosis is more advanced cancer metastasis, but there is no firm adhesion to the internal carotid artery or anterior fascia. The primary site of cancer is still hopeful to control, no distant organ cancer metastasis. Radical neck lymphadenectomy can also be performed. 3. In the case of cervical cancer with cervical lymph node metastasis, in order to obtain treatment time, radical neck lymph node resection can be completed at the same time as full laryngectomy. Even if there are bilateral cervical lymph node metastasis, bilateral lymph node resection can be performed, but the contralateral surgery is preferably postponed 2 weeks after the first operation, so that there is time to train the internal jugular vein to adapt to intracranial venous return. 4. There is a high probability of clinically cervical lymph node metastasis in a small number of cases, and there is a lack of close follow-up conditions for preventive resection. 5. For N1 localized cervical lymph node metastasis, functional cervical lymph node dissection can be used. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation 1. Before the operation, you must do a more detailed physical examination, including chest X-ray and liver and kidney function tests. Patients with suspected cardiovascular diseases should be examined by electrocardiogram and properly treated with medical consultation. 2. Prepare blood. 3. Patients with laryngeal cancer, if there is a laryngeal obstruction, it is advisable to perform a tracheotomy before surgery. Surgical procedure (a) radical neck lymph node resection 1. Position: In order to make the surgical field well exposed, the patient is lying down, shoulders, head tilted back and turned to the opposite side. 2. Incisions: Commonly used are forked and double-forked incisions. The lower end flap of the fork-shaped incision has better blood supply and is beneficial for healing. The double-forked incision can fully expose the triangular areas of the neck and facilitate extensive resection. The method is as follows: (1) The first incision: from the tip of the mastoid, the anterior border of the sternocleidomastoid muscle starts from a horizontal finger, and is made to go down and then forward until the midline of the neck. . The distance from the mandible is about 1 to 112 cm. The lowest branch of the facial nerve is the mandibular marginal nerve, located at the lower edge of the mandible, which is equivalent to the surface of the external and external arteries. When incision, care should be taken not to cut the nerve to avoid paralysis of the lower lip of the operation side. (2) The second incision: at the junction of the first incision and the anterior border of the sternocleidomastoid muscle, vertically downward, across the sternocleidomastoid muscle until a transverse finger on the collarbone. (3) Third incision: extending from the end of the second incision to the midpoint of the sternum, back to the outside of the clavicle. 3. Peeling the flap: Separating along the incision under the platysma, ranging from the lower edge of the mandible to the upper edge of the clavicle, from the median line of the anterior neck to the anterior border of the trapezius. In order to ensure the blood supply of the flap and reduce the postoperative scar contraction, subcutaneous fat and platysma should be preserved, but the platysma should be removed when the shallow lymph nodes of the neck have metastasized. 4. Ligation of the external jugular vein: the external jugular vein is located on the surface of the sternocleidomastoid muscle and should be ligated. 5. Cut off the lower end of the sternocleidomastoid: Cut the deep fascia of the neck along the upper edge of the clavicle, expose the sternocleidomastoid muscle, and separate it from the deep tissue. Cut the sternal and clavicular ends at 1 to 2 cm above the collarbone. And ligature with a thick thread. 6. Ligation of the lower end of the internal jugular vein: the lower end of the internal jugular vein and the surrounding tissue are fully freed, and the thick wire is introduced from the deep internal jugular vein with a curved vascular clamp, and the two veins are ligated at 1 to 2 cm on the collarbone, and the vein is cut. At the lower end, two wires need to be ligated with a silk thread to prevent the ligature from falling off and causing severe bleeding. 7. Excision of the posterior triangle of the neck, the sternocleidomastoid and the internal jugular vein are turned up, the scapulae muscle is exposed, and the scapula is ligated and cut up after the scapula, and along the upper edge of the collarbone, from the bottom The lymphatic tissue and adipose tissue in the upper triangular region of the clavicle are removed. At this time, the transverse artery of the neck should be ligated and cut off to avoid bleeding. Then, the lymphatic tissue of the occipital triangle is removed along the leading edge of the trapezius muscle. The accessory nerve is visible on the anterior edge of the trapezius muscle. Because the lymphatic tissue around the phrenic nerve is abundant, it should be removed. The above surgical operations are performed along the anterior vertebral fascia. After the isolated neck muscles, veins, lymph nodes, etc. are turned up, the anterior fascia and its deep scalene, brachial plexus, and sacral nerves can be seen. Avoid damage in the middle. 8. Treatment of the carotid triangle: head and neck tumors are most prone to lymph node metastasis around the carotid sheath, so the removal of lymph nodes should be as thorough as possible. Separate the sternocleidomastoid muscle and the internal jugular vein from the carotid sheath, and go up to the level of the hyoid bone. Forward to the muscles around the hyoid bone, avoid damage to the carotid artery and the vagus nerve during surgery. If the metastatic lymph nodes have adhered to the carotid artery, they can be separated along the arterial wall to avoid peeling off the carotid artery wall. 9. Treatment of the inferior triangle and submandibular triangle along the lower edge of the mandible, from the mandibular angle to the midline of the neck, incision of the deep fascia, at the midline, separation from top to bottom, clearing the infraorbital triangle lymph nodes, Connect it to the neck tissue block that is removed from the bottom up. The second abdominal muscles were cut and the submandibular glands were exposed. It was excised together with adjacent lymphoid tissue, and the submandibular gland was ligated with a silk thread and then cut. When cutting the abdominal muscles, the sublingual nerve injury in the lower abdomen of the second abdominal muscle should be avoided. 10. Cut off the sternocleidomastoid and the internal jugular vein of the upper end of the neck of the triangle and the lymph nodes have been largely free, cut 1 to 2 cm below the tip of the mastoid, ligation of the sternocleidomastoid muscle, and separate, The upper end of the internal jugular vein was cut and sewed, and the lymph nodes of the triangular regions of the neck were removed. A negative pressure drainage tube is placed in the submandibular area to the supraclavicular area. The skin is sutured and the wound is pressure-wrapped. If radical neck dissection is performed simultaneously with total laryngectomy, the whole laryngectomy can be performed after the cervical lymphatic tissue is removed. (B) functional neck lymph node resection 1. Incision: The outer edge of the mandibular angle of the affected side is curved along the anterior border of the sternocleidomastoid muscle to the upper sternal fossa. If a bilateral functional cervical lymph node resection is performed at the same time, the opposite side is made into the same arc-shaped incision, and the two arc-shaped incisions are connected to form a "" type. 2. Peeling the flap: Separate the flap from the platysma, forward to the midline of the neck, and back to the leading edge of the trapezius. 3. Ligation of the external jugular vein: the upper and lower ends of the sternocleidomastoid muscle are separated, and two gauze strips are passed through the upper and lower ends of the muscle to pull it back. Exposure and severing of the external jugular vein. 4. Clean the lymphatic tissues in the front of the neck: Separate the internal jugular vein and the vagus nerve from the top of the supraclavicular bone, cut off the scapula and remove the carotid sheath. Under the premise of retaining the internal carotid artery, vein and vagus nerve, the fat, lymphoid tissue, fascia and interstitial tissues of the anterior cervical region were cleaned from the bottom to the top; the submandibular gland, the second abdominal muscle and the hypoglossal nerve were preserved. 5. Clean the lymphoid tissues in the posterior area of the neck: Pull the sternocleidomastoid muscle to the front of the neck, and clean the fat, lymphoid tissue and fascia of each area after the neck from the supraclavicular fossa, and preserve the transverse carotid artery and accessory nerve. If the contralateral side also requires functional cervical lymph node resection, the same surgical procedure is used. It is also possible to perform surgery such as total laryngectomy or laryngeal cancer resection. complication infection.