甲状腺切除联合同期双侧颈淋巴结清扫术治疗分化型甲状腺癌  

One stage thyroidectomy and bilateral neck dissection for well-differentiated thyroid carcinoma

作　　者：潘贻飞[1] 张筱骅[1] 叶国华[1] 林包荣[1] 陈雪敏[1] 贾新建[1] 周素梅[1] 王瓯晨[1] 

机构地区：[1]温州医学院附属第一医院肿瘤外科,325000

出　　处：《中华肿瘤杂志》2006年第5期389-392,共4页Chinese Journal of Oncology

摘　　要：目的探讨分化型甲状腺癌行甲状腺切除联合同期双侧颈淋巴结清扫(颈清)术的安全性、适应证和手术难点。方法对1991年1月至2004年6月我科收治的分化型甲状腺癌行甲状腺切除联合同期双侧颈清术患者36例作回顾性分析,手术切口选择根据原发癌灶的位置及颈淋巴结可疑转移情况,选择相应的H型、L型或衣领式,甲状腺组织行近全切或全切,双侧颈清术原则上按保留颈内静脉、副神经、胸锁乳突肌改良颈清术式进行。结果全组36例患者无一例手术死亡,术后并发症为创口出血2例,一侧喉返神经损伤4例,一侧喉上神经内支损伤2例,一侧喉上神经外支损伤 9例,一侧副神经损伤3例,一侧颈交感神经损伤5例,一侧膈神经损伤2例,一侧乳糜瘘6例,暂时性甲状旁腺功能减退13例,永久性甲状旁腺功能减退3例。淋巴结阳性数0-21个,平均8．3个／例, 双侧淋巴结均阳性31／36,一侧淋巴结阳性,另一侧淋巴结阴性3／36,双侧淋巴结均阴性2／36。经 1-13年随访,4例死亡,7例失访,25例存活,3例复发。结论分化型甲状腺癌行甲状腺切除联合同期双侧颈清术是安全的,关键是至少保留一侧颈内静脉,不要同时损伤双侧喉返神经和膈神经; 对双侧颈淋巴结病理证实转移或临床判断转移(淋巴结明显肿大、质地偏硬或淋巴结为典型的紫葡萄颜色)的分化型甲状腺癌,均应行甲状腺切除联合同期双侧颈清;至少保留一个有血供的甲状旁腺;尽可能将甲状腺组织近全切或全切;应兼顾手术彻底性和机体功能保留。Objective To investigate the indications, safety and difficulties of one stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma . Methods A retrospective review was carried out in 36 well-differentiated thyroid carcinoma patients so treated from 1990 to 2004. Various incisions including H, L and modified Kocher types were selected according to the location of primary tumor and status of cervical lymph node metastasis. Either total thyroidectomy or sub-total thyroidectomy combined with bilateral neck lymph node dissection according to the principles of modified radical neck lymph node dissection： preserving the internal jugular vein, spinal accessory nerve and sternocleidomastoid muscles. Results There was no operative death in this group. Postoperative complications included： 2 wound bleeding, 3 recurrent laryngeal nerve resection due to tumor involvement, 1 recurrent laryngeal nerve injury, 2 unilateral internal branch of superior laryngeal nerve injury, 9 unilateral external branch of superior laryngeal nerve injury, 3 unilateral accessory nerve injury, 5 unilateral sympathetic nerve injury, 2 unilateral phrenic nerve injury, 6 chylus fistula, 13 temporary hypoparathyroidism, 2 permanent hypoparathyroidism. The dissected lymph nodes were found to be positive from 0 to 21 in each patient with a mean of 8.3. Of the 36 patients： 31 had bilateral positive lymph nodes; 3 unilateral positive; 2 bilateral negative lymph nodes. The follow up period ranged from 1 to 13 years, Three patients died of distant metastasis, 1 died of cerebral vescular accident. 7 patients lost in follow-up. Totally, 25 patients are still alive, 3 patients had local relapse and were surgically treated again. Conclusion The procedure of one-stage thyroidectomy and bilateral neck lymph node dissection for well- differentiated thyroid carcinoma is safe, as it is mandatory that at least one unilateral internal jugular vein should be preserved; one unilateral recurrent laryngeal nerves and acces

关 键 词：甲状腺肿瘤 外科学 淋巴转移 颈淋巴结清扫术 甲状腺切除 

分 类 号：R736.1[医药卫生—肿瘤] R653[医药卫生—临床医学]