Cervical Lymph Biopsy Needle Should Pay Attention To Which Structures Are Injured

Mainly the peripheral nerves and blood vessels

1. Internal jugular vein injury or loosening of ligation line: the wall of the internal jugular vein is thin, and the separation should be careful to avoid serious bleeding caused by injury. If the vein wall is broken, the two ends of the breach should be pressed immediately and repaired and sutured.

Detachment of the ligature at the upper and lower ends of the internal jugular vein may cause air embolism in addition to severe bleeding. Therefore, after the broken end of the internal jugular vein is ligated with silk thread, it should be seamed twice with silk thread to avoid the ligation line falling off.

2, metastatic lymph nodes and carotid artery adhesion: such as metastatic cervical lymph node and external carotid artery adhesion, if necessary, the external carotid artery ligation can be cut off, and the cervical lymph node resection together. Due to the ligation of the common carotid artery or internal carotid artery, may lead to hemiplegia, so it should be very careful, generally not ligation. Sometimes the adherent lymph nodes can be removed gently along the arterial wall. Dissection must not make the carotid artery dissection, but often can not achieve a radical cure.

3. Lingual nerve, vagus nerve, hypoglossal nerve, phrenic nerve or brachial plexus injury: when separating, ligation and cutting the internal jugular vein, pay attention not to ligation and cutting the vagus nerve behind the internal jugular vein together with the internal jugular vein. There is hypoglossal nerve under the posterior abdomen of the digastric muscle, which cannot be mistaken for the digastric muscle tendon being cut, so as not to cause ipsilateral lingual muscle atrophy and movement disorders. When cleaning the submaxillary triangle area, the lingual nerve can be seen near the submandibular gland. When cutting the submandibular gland canal, it must be distinguished from the lingual nerve. When cleaning the posterior cervical triangle, it should be done in front of the prevertebral fascia, and should not be too deep to avoid injury to the brachial plexus and phrenic nerve.

4, skin flap infection necrosis after radical neck lymph node resection, such as skin flap infection necrosis, can affect wound healing. Necrosis is most likely to occur at the tip of the flap. If part of the subcutaneous fat is preserved during the dissection of the flap, the skin flap is often protected with saline gauze during the operation, which can reduce the injury. After proper treatment of necrotic flaps, the wound can heal gradually. If the necrotic area is large and the infection is deep, it may cause massive bleeding, and special attention should be paid.

5. Lymphatic leakage should not be too low when removing the supraclavicular trigone tissue to prevent injury to the thoracic duct. Because the position of the left thoracic duct is higher than that of the right lymphatic duct, the chance of injury is more than that of the right side. If the thoracic duct is accidentally injured, lymphatic extravasation can occur, and a large amount of rice water-like exudate leaks out of the postoperative wound. It should be timely pressurized and bandaged, antibiotics and fluid replacement should be applied, and the wound can be closed and healed within a few days. If the exudation continues, reoperation should be performed to look for ligation.

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