Tran Justin, Zafereo Mark
Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
VideoEndocrinology. 2019 Mar 18;6(1). doi: 10.1089/ve.2018.0141. eCollection 2019.
Although lymph node metastases are common with papillary thyroid cancer, parapharyngeal and retropharyngeal lymph node metastases are relatively rare. Although small metastatic parapharyngeal lymph nodes (e.g., <1 cm) may be treated with radioactive iodine or observed, larger lymph nodes may require surgical excision. Surgical approaches to the parapharyngeal and retropharyngeal space include transoral and transcervical. A 47-year-old female presented with a 2 cm conventional papillary thyroid cancer in the right thyroid lobe with central right lateral neck metastases, as well as a 2.5 cm right parapharyngeal lymph node metastasis extending to the skull base. Surgical technique for transcervical resection of the 2.5 cm parapharyngeal lymph node is illustrated, identifying important anatomical structures. After opening the right neck and removing the right level 2 lymph nodes (not illustrated), the parapharyngeal space is exposed. First, the posterior belly of the digastric and stylohyoid muscles is divided. Next, the hypoglossal nerve is identified and mobilized. Branches of the external carotid artery are then divided and retracted. The sympathetic chain is visualized posterior to the internal carotid artery. The external branch of the superior laryngeal nerve is visualized as it courses posterior to the carotid artery. After gentle retraction of the hypoglossal nerve, superior laryngeal nerve, carotid artery, and sympathetic chain, the parapharyngeal space is exposed with the aforementioned metastatic lymph node. The metastatic lymph node is then freed from the alar fascial and skull base attachments and removed en bloc. To our knowledge, this is the first video demonstration of a transcervical parapharyngeal lymph node resection in the peer-reviewed literature. Transcervical excision of parapharyngeal and retropharyngeal lymph nodes requires a thorough understanding of the anatomy of the neck and parapharyngeal space, along with a stepwise surgical technique to safely expose the parapharyngeal space. No competing financial interests exist. Runtime of video: 8 mins 44 secs.
虽然甲状腺乳头状癌常见有淋巴结转移，但咽旁和咽后淋巴结转移相对少见。虽然小的咽旁转移淋巴结（如<1厘米）可用放射性碘治疗或观察，但较大的淋巴结可能需要手术切除。进入咽旁和咽后间隙的手术方法包括经口和经颈入路。一名47岁女性，右侧甲状腺叶有一个2厘米的经典型乳头状甲状腺癌，伴有右侧颈部中央淋巴结转移，以及一个2.5厘米的右侧咽旁淋巴结转移灶，该转移灶延伸至颅底。本文展示了经颈切除2.5厘米咽旁淋巴结的手术技术，并识别了重要的解剖结构。打开右侧颈部并切除右侧2区淋巴结后（未展示），暴露咽旁间隙。首先，切断二腹肌后腹和茎突舌骨肌。接着，识别并游离舌下神经。然后切断并牵开颈外动脉分支。在颈内动脉后方可见交感神经链。喉上神经外支在颈动脉后方走行时可见。轻轻牵开舌下神经、喉上神经、颈动脉和交感神经链后，暴露咽旁间隙及上述转移淋巴结。然后将转移淋巴结从翼筋膜和颅底附着处游离并整块切除。据我们所知，这是同行评审文献中首例经颈咽旁淋巴结切除术的视频演示。经颈切除咽旁和咽后淋巴结需要全面了解颈部和咽旁间隙的解剖结构，以及逐步的手术技术以安全暴露咽旁间隙。不存在利益冲突。视频时长：8分44秒。
