颈淋巴结清扫术

1、Neck Dissection张杰Nanjing Army General HospitalContentsLymph Nodes Levels and Staging1Drainage2Classfication of ND3Procedure of Selective ND4Sloan Kettering nomenclature(1991)IaSubmentalIbSubmandibularIIaUpper jugular (Anterior to XI)IIb Upper jugular (Posterior to XI)IIIMiddle jugularIVaLower jugula

2、r (Clavicular)IVbLower jugular (Sternal)VaPosterior triangle (XI)VbPosterior triangle (Transverse cervical)VICentral compartmentVII Super1.Lymph Nodes LevelsN2N3N1Single ipsilateral lymph node, 3 cmN2a: Single ipsilateral lymph node 3 to 6 cmN2b: Multiple ipsilateral lymph nodes 6 cm N2c: Bilateral

3、or contralateral nodes 6 cmStagingNasopharynxRetropharyngeal,II,III,VOropharynxIIbIIa,III,IV,VLarygopharynxII,III,RetropharyngealLarynxSupraglotticIIaIIb,III,IVSubglotticVI,IVCervicalesophagusIV,VIThyroidVI,IV,V,Mediastinal2.Nodal DrainageNanjing Army General Hospital3.Neck dissection Classification

4、Radical Neck Dissection(RND) Neck Dissection(ND)Functional Neck Dissection(FND) Nanjing Army General Hospital RNDSMGLevel I-VIIJVXISCMRNDRadical Neck DissectionNanjing Army General HospitalClassificationRemoval of additional lymph node groups or non lymphatic structuresGold standard operationPreserv

5、ation of non-lymphatic structuresPreservation of lymph node groupsExtendedRadicalModified RadicalSelectiveModified NDType: preserving the spinal acessory nerve.The en bloc removal of the lymph-node-bearing tissue is from levels I through VI.The IJV and the SCM are resectecd. Type: preserving the spi

6、nal accessory nerve and the IJV.The lymph-node-bearing tissues of one side of the neck are removed en bloc from levels I through VI.The SCM is resected.Type: preserving the spinal accessory nerve, the IJV, and the SCM.The lymph nodes removed include levels through .The submandibular gland may or may

7、 not be removed .Nanjing Army General HospitalSelective NDFour subtype:Supraomohyoid ND (A)Lateral ND (B)Posterolateral ND (C)Anterior ND(D)vRemoval of lymph nodes contained in level I, II, and III. vThe posterior limit is marked by the cutaneous branches of the cervical plexus and the posterior bor

8、der of the sternocleidomastoid muscle.vThe inferior limit is the superior belly of the omohyoid muscle where it crosses the internal jugular vein. (A) Supraomohyoid neck dissectionvRemoval of the lymph nodes from level II to IV . vThe posterior limit is marked by the splenius muscle superiorly and t

9、he cutaneous branches of the cervical plexus inferiorly.(B) Lateral neck dissection vRemoval of the suboccipital lymph nodes, retroauricular lymph nodes and levels II V.vThis procedure is mostly used to remove nodal disease from cutaneous melanoma of the posterior scalp and neck(C) Posterolateral ne

10、ck dissectionvThe lymph nodes include the pretracheal, the paratracheal, the perithyroidal, and the pre cricoid (Delphian) (level VI). vThe superior limit is the hyoid bone; the inferior limit is the suprasternal notch; the lateral limits are the common carotid arteries.vIt is most frequently indica

11、ted in the treatment of thyroid caner.(D) Anterior compartment neck dissection Extended ND vRemoval of one or more additional lymph node groups and/or nonlymphatic structures not encompassed by radical neck dissection. vExamples of such lymph node groups include the parapharyngeal, superior mediastinal, and paratrache