颈淋巴结清扫术PPT参考课件

1、Neck Dissection,张杰,1,Contents,2,Sloan Kettering nomenclature(1991) IaSubmental IbSubmandibular IIaUpper jugular (Anterior to XI) IIb Upper jugular (Posterior to XI) IIIMiddle jugular IVaLower jugular (Clavicular) IVbLower jugular (Sternal) VaPosterior triangle (XI) VbPosterior triangle (Transverse c

2、ervical) VICentral compartment VII Super,1.Lymph Nodes Levels,3,Staging,4,2.Nodal Drainage,5,3.Neck dissection Classification,6,RND,7,Classification,8,Modified ND,Type: preserving the spinal acessory nerve. The en bloc removal of the lymph-node-bearing tissue is from levels I through VI. The IJV and

3、 the SCM are resectecd.,9,Type: preserving the spinal 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.,10,Type: preserving the spinal accessory nerve, the IJV, and the SCM. The lymph nodes removed i

4、nclude levels through . The submandibular gland may or may not be removed .,11,Selective ND,Four subtype: Supraomohyoid ND (A) Lateral ND (B) Posterolateral ND (C) Anterior ND(D),12,Removal of lymph nodes contained in level I, II, and III. The posterior limit is marked by the cutaneous branches of t

5、he cervical plexus and the posterior border of the sternocleidomastoid muscle. The inferior limit is the superior belly of the omohyoid muscle where it crosses the internal jugular vein.,(A) Supraomohyoid neck dissection,13,Removal of the lymph nodes from level II to IV . The posterior limit is mark

6、ed by the splenius muscle superiorly and the cutaneous branches of the cervical plexus inferiorly.,(B) Lateral neck dissection,14,Removal of the suboccipital lymph nodes, retroauricular lymph nodes and levels II V. This procedure is mostly used to remove nodal disease from cutaneous melanoma of the

7、posterior scalp and neck,(C) Posterolateral neck dissection,15,The lymph nodes include the pretracheal, the paratracheal, the perithyroidal, and the pre cricoid (Delphian) (level VI). The superior limit is the hyoid bone; the inferior limit is the suprasternal notch; the lateral limits are the commo

8、n carotid arteries. It is most frequently indicated in the treatment of thyroid caner.,(D) Anterior compartment neck dissection,16,Extended ND,Removal of one or more additional lymph node groups and/or nonlymphatic structures not encompassed by radical neck dissection. Examples of such lymph node groups include the parapharyngeal, superior mediastinal, and paratracheal lymph nodes. Examples of nonlymphatic structures include the carotid arter