颈淋巴结清扫术ppt参考课件

NeckDissection12020/3/15ContentsLymphNodesLevelsandStaging1Drainage2ClassficationofND3ProcedureofSelectiveND422020/3/15SloanKetteringnomenclature(1991)Ia

SubmentalIb

SubmandibularIIa Upperjugular(AnteriortoXI)IIb Upperjugular(PosteriortoXI)III MiddlejugularIVa Lowerjugular(Clavicular)IVb Lowerjugular(Sternal)Va Posteriortriangle(XI)Vb Posteriortriangle(Transversecervical)VI CentralcompartmentVII

Super1.LymphNodesLevels32020/3/15N2N3N1Singleipsilaterallymphnode,<3cmN2a:Singleipsilaterallymphnode3to6cmN2b:Multipleipsilaterallymphnodes<6cmN2c:Bilateralorcontralateralnodes<6cmMetastases>6cmStaging42020/3/15Nasopharynx

Retropharyngeal,II,III,VOropharynx

IIb>IIa,III,IV,VLarygopharynxII,III,RetropharyngealLarynxSupraglotticIIa>IIb,III,IV

SubglotticVI,IVCervicalesophagus

IV,VIThyroid

VI,IV,V,Mediastinal2.NodalDrainage52020/3/153.NeckdissectionClassificationRadicalNeckDissection(RND)

NeckDissection(ND)FunctionalNeckDissection(FND)

62020/3/15

RNDSMGLevel

I-VIIJVXISCMRNDRadicalNeckDissection72020/3/15ClassificationRemovalofadditionallymphnodegroupsornonlymphaticstructuresGoldstandardoperationPreservationofnon-lymphaticstructuresPreservationoflymphnodegroupsExtendedRadicalModifiedRadicalSelective82020/3/15ModifiedNDTypeⅠ:preservingthespinalacessorynerve.Theenblocremovalofthelymph-node-bearingtissueisfromlevelsIthroughVI.TheIJVandtheSCMareresectecd.92020/3/15TypeⅡ:preservingthespinalaccessorynerveandtheIJV.Thelymph-node-bearingtissuesofonesideoftheneckareremovedenblocfromlevelsIthroughVI.TheSCMisresected.102020/3/15TypeⅢ:preservingthespinalaccessorynerve,theIJV,andtheSCM.ThelymphnodesremovedincludelevelsⅠthroughⅤ.Thesubmandibularglandmayormaynotberemoved.112020/3/15SelectiveNDFoursubtype:SupraomohyoidND(A)LateralND(B)PosterolateralND(C)AnteriorND(D)122020/3/15RemovaloflymphnodescontainedinlevelI,II,andIII.Theposteriorlimitismarkedbythecutaneousbranchesofthecervicalplexusandtheposterior

borderofthesternocleidomastoidmuscle.Theinferiorlimitisthesuperiorbellyoftheomohyoidmusclewhereitcrossestheinternaljugularvein.(A)Supraomohyoidneckdissection132020/3/15RemovalofthelymphnodesfromlevelIItoIV.Theposteriorlimitismarkedbythespleniusmusclesuperiorlyandthecutaneousbranchesofthecervicalplexusinferiorly.(B)Lateralneckdissection

142020/3/15Removalofthesuboccipitallymphnodes,retroauricularlymphnodesandlevelsII–V.Thisprocedureismostlyusedtoremovenodaldiseasefromcutaneousmelanomaoftheposteriorscalpandneck(C)Posterolateralneckdissection152020/3/15Thelymphnodesincludethepretracheal,theparatracheal,theperithyroidal,andtheprecricoid

(Delphian)(levelVI).Thesuperiorlimitisthehyoidbone;theinferiorlimitisthesuprasternalnotch;thelaterallimitsarethecommoncarotidarteries.Itismostfrequentlyindicatedinthetreatmentofthyroidcaner.(D)Anteriorcompartmentneckdissection162020/3/15ExtendedND

Removalofoneormoreadditionallymphnodegroupsand/ornonlymphaticstructuresnotencompassedbyradicalneckdissection.Examplesofsuchlymphnodegroupsincludetheparapharyngeal,superiormediastinal,andparatracheallymphnodes.Examplesofnonlymphaticstructuresincludethecarotidartery,hypoglossalnerve,vagusnerve,andparaspinalmuscles