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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。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 % (2 7/ 33)副神经穿过胸锁乳突肌 ,1 8% (6/ 33)在胸锁乳突肌深面行走 ;85 % (2 8/ 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 % (2 3/ 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 2 0～ 30min ;术后病理证实 2 7% (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
Objective To investigate the anatomy and preservation of the accessory nerve in functional radical cervical lymph node dissection. Methods Three cases of functional neck radical neck dissection were performed on 33 cases of oral cancer patients with negative cervical lymph nodes before operation. Describe the method of searching for and preserving the accessory nerve and record the relationship between the accessory nerve and the surrounding structure, the time of operation and the result of postoperative pathological examination of lymph nodes. Results 82% (27/33) of the accessory nerves passed through the sternocleidomastoid muscle and 18% (6/33) of the sternocleidomastoid muscles deep; 85% (28/33) of the accessory nerves and cervical nerves The anastomosis traffic branch exists among the roots; the accessory nerve passes the muscle within 2 cm beyond the midpoint of the trailing edge of the sternocleidomastoid muscle of the large auricle; 70% (2 3/33) 3cm and the front of the muscle parallel to the downstream descent into the muscle; Paranasal nerve free, anatomical time of about 20 ~ 30min; pathological confirmed 27% (9/33) cases of cervical lymph node metastasis. Conclusions It is easy to look for the accessory nerve in the midpoint of the sternum and the posterior border of the sternocleidomastoid muscle. The midpoint of the posterior edge of the sternocleidomastoid muscle is an important anatomic landmark to help find the accessory nerve