副神經與內頸靜脈之間的解剖變異－病例報告及文獻回顧

Anatomic Variations between the Spinal Accessory Nerve and Internal Jugular Vein - A Case Report and Review of the Literatures

王聖中(Sheng-Chung Wang) ； 王峙仁(Chih-Jen Wang)

《臺灣口腔顎面外科學會雜誌》 30卷3期 (2019/09) Pp. 217-223

摘要

頸部淋巴廓清術治療之後，常見的併發症是關於肩膀的疼痛和功能問題，追溯其原因跟副神經有著很大的關聯，而二腹肌的後腹是整個手術中遇到副神經最常見的解剖位置。時至今日所發表的文獻中可以發現，內頸靜脈和副神經在解剖構造上的相對走向關係一直存在著很大的爭論及差異。了解此重要解剖構造的變異有助於降低醫源性傷害的發生率。本案例報告為一位51歲男性因右側頰黏膜有一潰瘍未癒合硬結腫塊持續半年並接受手術治療，術後診斷為鱗狀上皮細胞癌，在實施頸部淋巴廓清術中發現其副神經走向為罕見的貫穿內頸靜脈類型，患者術後持續追縱四年並無肩膀酸疼及運動上的障礙，本文提出此一病例報告並回顧文獻及討論。

關鍵字

副神經 ； 內頸靜脈 ； 功能性頸部淋巴廓清術

並列摘要

Cervical lymphadenectomy is the routine treatment of oral cancer. After the treatment, the common complications are shoulder pain and dysfunction. The cause of these uncomfortable symptoms is highly correlated with the spinal accessory nerve (SAN). During the surgery, the posterior belly of digastric muscle is the most general location where the spinal accessory nerve can be noticed. To date, there is a controversy over anatomy relationship between the internal jugular vein (IJV) and the spinal accessory nerve. By understanding the variation of this relationship might help reduce the incidence of iatrogenic injuries. This is a case of 51-year-old male who had an unhealed ulcerative induration mass over the right buccal mucosa for half a year, and he had received surgery. The postoperative diagnosis was squamous cell carcinoma. During the surgery of cervical lymphadenectomy, we found that the SAN piercing the IJV which is a rare anatomic variation. The patient recovered well and without any shoulder problems. We present this case with the literature review and discussion.

並列關鍵字

Spinal accessory nerve ； Internal jugular vein ； Functional neck dissection