London J, London N J, Kay S P
Department of Plastic and Reconstructive Surgery, St James's University Hospital, Leeds.
Ann R Coll Surg Engl. 1996 Mar;78(2):146-50.
Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures. The problem is frequently compounded by a failure to recognise the error immediately after surgery when surgical repair has the greatest chance of success. We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of nerve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, when indicated, surgery in this region should be performed by suitably trained staff under well-defined conditions. Awareness of iatrogenic injury and its consequences would avoid delays in diagnosis and treatment.
副神经损伤会导致严重残疾。该神经最常因根治性颈清扫术、颈部淋巴结活检及其他外科手术的并发症而受损。术后未能立即识别错误（此时手术修复成功几率最大）常使问题复杂化。我们呈现的病例概述了副神经损伤的风险、临床表现范围以及未能识别功能缺陷所产生的问题。文中讨论了局部解剖、神经损伤后果及处理方法。颈部淋巴结诊断性活检不应作为首要检查，如有必要，该区域手术应由经过适当培训的人员在明确条件下进行。认识到医源性损伤及其后果可避免诊断和治疗的延误。
