功能性根治性颈淋巴清扫术中的副神经手术解剖及保留方法

目的：探讨功能性根治性颈淋巴结清扫术中的副神经解剖及保留方法。对33例口腔癌患者术前颈部淋巴结检查阴性者行三保留功能性根治性颈清扫术。介绍副神经的寻找及保留方法，记录副神经与周围结构关系、手术时间及术后淋巴结病理检查结果等。结果：82％（27／33）副神经穿过胸锁乳突肌，18％（6／33）在胸锁乳突肌深面行走；85％（28／33）副神经和颈神经根间存在吻合交通支；副神经在耳大神经出胸锁乳突肌后缘中点上方2cm范围内出该肌；70％（23／33）副神经在进入斜方肌前约2－3cm基本与该肌前缘平行下行后进入该肌；副神经游离；解剖时间约20－30min；术后病理证实27％（9／33）病例颈淋巴结转移。结论：在胸锁乳突肌前缘上份深面及后缘中点上易于寻找副神经，耳大神经出胸锁乳突肌后缘中点是协助寻找副神经的重要解剖标志。

Surgical anatomy and preservation of the accessory nerve in radical functional neck dissection

Objective The surgical anatomy and preservation of the accessory nerve in radical functional neck dissection were studied. Methods Thirty three cN 0 patients with oral cancers were entered into the study. Radical functional neck dissection were performed and the relations between the accessory nerve and its surrounding structures were recorded. Results The accessory nerve going through or beneath the sternocleidomastoid muscle occurred in 82%(27/33)and 18%(6/33)of the patients respectively. Communicating branches between the accessory and the cervical nerves were found in 85%(28/33). There was 2 to 3 cm of the accessory nerve paralleled to the anterior boeder of the trapezius muscle before it entered the muscle in 70%(23/33). The dissection of the nerve needed 20 to 30 minutes. Twenty seven percent of the patients had pathologically proved lymph node metastases.Conclusions Looking for accessory nerve under the upper portion of the sternocleidomastoid muscle and above the middle point of the muscle posterior border is simple and safe. The point of the great auricular nerve going out the muscle is an important indicator for finding the accessory nerve.