甲状腺癌改良颈部淋巴结清扫术英文手术记录(霍普金斯医院).doc

Title of Operation:Left modified radical neck dissection, recurrent laryngeal nerve monitoring.Intraoperative ultrasound.Indications for Surgery:Preoperative Diagnosis:Metastatic papillary thyroid cancer.Postoperative Diagnosis:Anesthesia:Specimen (Bacteriological, Pathological or other):Prosthetic Device/Implant:Surgeons Narrative:Operative Findings:Significant lymphadenopathy within levels II, III, and IV.Operative Procedure:Under general anesthesia, the patient was placed in a semi-Fowler position with a neck hyperextended.SCDs are up and working prior to anesthesia.An ultrasound was performed to localize the lymphadenopathy, it was noted to be present in levels II, III, and IV on the left.This should be a redo left modified radical neck dissection. The old Kocher incision was opened and extended laterally toward the auricle. Skin and subcutaneous tissues were opened sharply.Bleeding vessels were cauterized.Platysma was opened sharply.The greater auricular nerve was noted and carefully preserved. Inferior flap down to the clavicle and sternal notch was performed, and superior flap up to thyroid cartilage and submandibular gland was performed.The marginal mandibular nerve was noting carefully preserved.Its function was documented with a recurrent laryngeal nerve monitor.Strap muscles were divided longitudinally in the midline retracted to the left.Blunt and sharp dissection revealed no evidence of metastatic disease within the central neck.Recurrent laryngeal nerve was noting carefully preserved. Its function was documented with a recurrent laryngeal nerve monitor.We also confirmed with ultrasonography that there was no lymphadenopathy in the left central neck.The fascia was anterior and posterior to the sternocleidomastoid was opened sharply and level V was carefully dissected after ligating the external jugular vein.Two cervical nerves were sacrificed during the dissection.The dissection occurred in medial fashion taking all the lymphatic tissue, superior and posterior, and medial to the jugular vein.The dissection occurred up to level II.The digastric was exposed as was the hypoglossal both were preserved.All the lymphatics from the clavicle up to the angle of the jaw were carefully dissected, and blood supply tied off with 2-0 or 3-0 silk suture.All the lymphatics around the jugular vein and subclavian vein juncture were ligated and tied with 2-0 or 3-0 silk suture.Level IV was separated from levels II and III and sent separately, and level II was marked with a short stay stitch and level III was marked with a long stitch.Recurrent laryngeal nerve throughout the entire operation function properly, documented with a recurrent laryngeal nerve monitor.The wound was then irrigated copiously with normal saline.Bleeding vessels were either retied or recauterized.Sternocleidomastoid was loosely approximated to strap muscles, and strap muscles were closed with running locking 3-0 Vicryl suture after placing a drain through a Jackson with a Jackson-Pratt drain #10 brought out through separate stab wound incision and sutured in place with 3-0 nylon.Gelfoam and thrombin were left within the wound. The platysma was then closed with interrupted 3-0 Vicryl suture and skin was closed with running subcuticular 4-0 Biosyn.Benzoin, Steri-Strips, and a dry sterile dressing were applied.The patient tolerated