modified cervical lymphadenectomy

Modified cervical lymph node dissection preserves the internal jugular vein, sternocleidomastoid and accessory nerves under the premise of achieving the purpose, and preserves function and shape. It is a relatively new and improved procedure. Treating diseases: thyroid cancer Indication Modified cervical lymph node dissection is suitable for thyroid cancer with a high degree of differentiation, lymph node metastasis without adhesion fixation. Preoperative preparation Smoking prevention will begin 2 weeks before surgery, and the infection of the respiratory tract should be strengthened to avoid postoperative respiratory inflammation and even serious complications caused by obstruction. Prepare the skin's range and shave a portion of the hair behind the ear to the back of the neck to avoid contaminating the surgical field. Surgical procedure 1. Generally, a single curved incision is used to cut the shallow deep fascia of the neck along the leading edge of the trapezius muscle. In the middle and lower 1/3 of the trapezius muscle front (5 cm from the upper edge of the clavicle), the deep fascial layer of the deep fascia can be found in the posterior margin of the sternocleidomastoid muscle, obliquely to the lower midpoint. The upper part of the posterior triangle of the neck enters the trapezius muscle and is fully dissociated over a section of the posterior triangle of the neck. 2. After the paracranial craniotomy, through the deep abdomen of the second abdomen and the deep surface of the styloid process, the lingual bone of the hyoid bone penetrates into the sternocleidoma at about 3.5 cm below the mastoid. Cut the deep fascia of the neck along the upper edge of the 1/3 segment of the clavicle, ligature and cut the lower abdomen of the scapula, expose the traverse and vein in the adipose tissue of the supraclavicular fossa, and dissect directly along the anterior fascia Outside the carotid sheath. Clear all lymph nodes, adipose tissue, etc. in the supraclavicular fossa. 3. The posterior margin of the free sternocleidomastoid muscle is lifted to the medial side, the carotid sheath is exposed, the carotid sheath is cut along the entire length of the internal jugular vein, and the internal jugular vein, vagus nerve and common carotid artery are fully dissociated. . The deep fascia was cut longitudinally along the entire length of the internal jugular vein. The anterior fascia was superficially dissected to the outside, and the soft tissue in the range from the lateral jugular vein to the leading edge of the trapezius muscle was completely removed, but the accessory nerve was retained. Anatomy of the sternocleidomastoid deep stalk, do not injure the deep blood vessels and nerves. When extensive exposure is required, the sternocleidomastoid muscle can be cut at the upper edge of the clavicle 1 to 2 cm, and the broken end of the muscle is repaired and sutured after the removal is completed. The sternocleidomastoid muscle was pulled to the lateral side, from the deep surface of the internal jugular vein, and the anterior fascia was dissected to the side of the trachea to expose the recurrent laryngeal nerve and clear the lymph nodes of the tracheal esophageal sulcus. On the surface of the trachea, the cervical fascia was cut longitudinally along the midline of the neck, and the anterior cervical muscle was removed. The specimen was turned upside down and dissected to the submandibular area, and the lymph nodes under the second abdominal muscle and the lower parotid gland were removed. Be careful not to injure the deep nerve trunk on the deep side of the sternocleidomastoid muscle. After separating the submandibular soft tissue, the lymph node adipose tissue in the posterior triangle of the neck and the anterior cervical triangle was cut in turn. 4. Wound treatment, suture, etc. are the same as traditional surgery.

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