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1、最新头颈癌的手术治疗-药学医学精品资料GeneralGoalsReviewtheindicationsformanagementofcervicalnodalmetastasisinheadandneckcancerIndicationsforselective,stagingneckdissectionNewertechniques,includingsentinelnodebiopsyLevelsoftheNeckIIVVIIIIIIVNeckDissectionStaging:Avarietyof
2、selectiveneckdissectionsforstagingofHNSCwithN0diseaseTherapy:UsuallyacomprehensiveneckdissectionforknownpresenceofdiseaseHistoricalApproachGeorgeCrile’sinitialdescriptionofneckdissection:bleedingcontrolledbyclampingofcommoncarotidartery“softeningofthebra
3、in”notedpostoperativelyRadicalneckdissection:removaloflevelsI-VInternalJugularVeinSternocleidomastoidCNXIRadicalNeckDissectionModifiedNeckDissectionModifiedneckdissection:preservationofoneormoreofthefollowingifnotdirectlyinvadedInternalJugularVeinSternoc
4、leidomastoidCNXISubmandibulargland,etc.(Boccaetal.1967)ComparisonofMRNDvs.RNDregionalrecurrenceRadicalNeckDissection13-16%ModifiedNeckDissection6-9%ImprovedshoulderfunctionwithCNXIpreservationNeckDissectionWithPreservationoftheSCM,IJ,andCNXISelectivevs.C
5、omprehensive/(I-V) NeckDissectionRemovalofaportionofnodalgroupsbasedonpreferentialmetastasesfromknownprimarysiteLindberg,Cancer,1972Buckley,HeadandNeck,2001PrimaryRationale:Staging,determinationofnodalinvolvementtoguidefurthertherapy,usuallyradiotherapyo
6、rconversiontocomprehensiveneckdissection(I-V)ifintraoperativediseaseSelectivevs.Comprehensive/(I-V) NeckDissectionSecondaryRationale:Therapy,clearanceofknownorsuspectednodaldiseaseControversyregardinguseastherapyforN+diseaseAdvantages:clearimprovementinp
7、ostoperativemorbidity,particularlyinCNXIfunctionComprehensiveNeckDissection: LevelsI-VSafe,accepted,traditionalmeansofaddressinganyN+necksurgicallyMajorstructuresrequiresacrificewheninvolvedwithtumorDistributionofNodalMetastases: OralCavityI30%II35%III23
8、%IV9%V2%LevelIVinOralCavitySelectiveNeckDissection16%ofpatientswithoraltonguecancerhaveisolatedpositivenodeinlevelIIIorlevelIV8%withisolatedlevelIVnodeinvolvementduringorafterneckdissectionByersetal.HeadandNeck,1997RiskofO
