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)

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1、TitleofOperation:Leftmodifiedradicalneckdissection,recurrentlaryngealnervemonitoring.Intraoperativeultrasound.IndicationsforSurgery:PreoperativeDiagnosis:Metastaticpapillarythyroidcancer.PostoperativeDiagnosis:Anesthesia:Specimen(Bacteriological,Path

2、ologicalorother):ProstheticDevice/Implant:SurgeonsNarrative:OperativeFindings:  SignificantlymphadenopathywithinlevelsII,III,andIV.OperativeProcedure:  Undergeneralanesthesia,thepatientwasplacedinasemi-Fowlerpositionwithaneckhyperextended.  SCDsareup

3、andworkingpriortoanesthesia.  Anultrasoundwasperformedtolocalizethelymphadenopathy,itwasnotedtobepresentinlevelsII,III,andIVontheleft.  Thisshouldbearedoleftmodifiedradicalneckdissection.TheoldKocherincisionwasopenedandextendedlaterallytowardtheauric

4、le.Skinandsubcutaneoustissueswereopenedsharply.  Bleedingvesselswerecauterized.  Platysmawasopenedsharply.  Thegreaterauricularnervewasnotedandcarefullypreserved.Inferiorflapdowntotheclavicleandsternalnotchwasperformed,andsuperiorflapuptothyroidcarti

5、lageandsubmandibularglandwasperformed.  Themarginalmandibularnervewasnotingcarefullypreserved.  Itsfunctionwasdocumentedwitharecurrentlaryngealnervemonitor.  Strapmusclesweredividedlongitudinallyinthemidlineretractedtotheleft.  Bluntandsharpdissectio

6、nrevealednoevidenceofmetastaticdiseasewithinthecentralneck.  Recurrentlaryngealnervewasnotingcarefullypreserved.Itsfunctionwasdocumentedwitharecurrentlaryngealnervemonitor.  Wealsoconfirmedwithultrasonographythattherewasnolymphadenopathyintheleftcent

7、ralneck.  ThefasciawasanteriorandposteriortothesternocleidomastoidwasopenedsharplyandlevelVwascarefullydissectedafterligatingtheexternaljugularvein.  Twocervicalnervesweresacrificedduringthedissection.  Thedissectionoccurredinmedialfashiontakingallth

8、elymphatictissue,superiorandposterior,andmedialtothejugularvein.  ThedissectionoccurreduptolevelII.  Thedigastricwasexposedaswasthehypoglossalbothwerepreserved.  Allthelymphaticsfromtheclavicleuptotheangleofthejawwerecarefullydissected,andbloodsupply