neck dissection

Cervical lymph node dissection is a whole process of resection of the neck lymphoid tissue and surrounding fat, muscle, nerves, blood vessels, etc., referred to as neck dissection, which has been the most widely used method for the treatment of cervical metastases. Treatment of diseases: esophageal cancer in the elderly Indication Oral, oropharynx, hypopharynx, larynx, cervical esophageal cancer, parotid gland, nasal cavity, paranasal sinus, ear, head and face skin, etc., the primary tumor has been controlled or removed, no distant metastasis, no Generalized neck dissection should be performed when the following conditions occur in the neck: 1. There is a clear clinical lymph node enlargement (except for some small lymph nodes with no lymph node invasion and differentiated thyroid cancer). 2, to perform cervical lymph node resection or biopsy, pathological confirmed as a case of metastatic cancer. 3. Cases of cervical lymph node metastasis that have not been controlled or relapsed after radical radiotherapy. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. 3, the original stove can not be removed clean (the naked eye is not clean) or can not be controlled. 4. There has been a distant transfer. 5, neck metastases can not be cut naked. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 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 Such as lymphatic leakage, wound infection, head and face edema, less serious complications of intracranial edema, neck veins after wound infection or even rupture and bleeding, especially after high-dose radiotherapy in the neck. Long-term complications include neck scar deformity and paresthesia.

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