分化型甲状腺癌行简化甲状腺癌改良根治术的合理性及临床应用  

Rationale and clinical application of simplified modified radical thyroidectomy for differentiated thyroid carcinoma

作　　者：章阳[1] 崔兆清[1] 孙善平[1] 任玉波[2] 许俊龙[2] 姚玉民[1] 陈启[1] 张伟[1] 李蕊[1] 关众[1] 焦德[1] 李文磊[1] 周长鑫[1] 

机构地区：[1]山东省聊城市人民医院乳腺甲状腺外科,252000 [2]山东省聊城市人民医院病理科,252000

出　　处：《中华内分泌外科杂志》2011年第2期103-105,共3页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨分化型甲状腺癌行简化甲状腺癌改良根治术的合理性及临床应用价值。方法自2007年1月至2010年6月在标准甲状腺癌改良根治术基础上简化操作过程（简称简化术式）治疗分化型甲状腺癌317例（349侧）。简化术式采取颈根部低位弧形顺皮纹小切口（约10～12cm），分离上下皮瓣，但不在皮下游离患侧胸锁乳突肌后缘及颈后三角皮下区域，可保护诸多通过这些区域穿出的感觉神经。无论原发灶大小、有无患侧颈部淋巴结转移的证据，均行甲状腺患侧叶＋峡部＋对侧叶次全切除术，并在患侧胸锁乳突肌深面清除主要转移区域（Ⅱa、Ⅲ、Ⅳ、Ⅴb区）的软组织。不常规显露副神经，以减轻对副神经的刺激。分组检测各区淋巴结转移率，比较不同术式术后并发症。结果简化术式避免了传统的“L”型或弧形长切口造成的明显疤痕及颈部活动受限的弊端；由于保留了全部肌肉及几乎全部神经支配，明显减轻或消除患侧颈肩部活动障碍及痛、麻、胀等异常感觉；缩短手术时间；全面了解颈部淋巴结状态，可准确评价病变的临床病理分期，为判断预后、制定综合治疗提供依据。结论简化术式在争取根治性切除和消除病变遗漏、复发隐患的前提下，最大程度地减轻创伤，提高术后生活质量，更加符合功能性根治的原则，为综合治疗提供依据。Objective To explore rationale and clinical application of simplified modified radical thyroidectomy for differentiated thyroid carcinoma. Methods From Jan. 2007 to Jun. 2010, 349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy. The simplified procedure took a low small collar incision （about 10 - 12 cm）. In separating upper and lower skin flaps, subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoe]eidomastoid muscle were spared to protect sensory nerves. Subtotal thyroidcctomy was performed to rcsect the affected lobe, isthmus, and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened. Soft tissues of the mainly metastatic areas （ Ⅱa、Ⅲ、Ⅳ、Ⅴb） were cleared. The accessory nerve was not exposed routinely to avoid stimulation. Lymph nodes metastasis in different areas was recor- ded respectively. Complications in different operative modes were compared. Results Compared with standard modified radical thyroidectomy, the simplified mode had shorter scar and no limit of neck mobility. Because of muscles and nerves perservation, movement dysfunction and abnormal sensation of neck and shoulder decreased obviously. The operation duration was shortened. Cervical lymph node status was evaluated, which provided basis for prognosis judgment and comprehensive treatment. Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy. It improvs the life quality of patients. This procedure fits the principle of functional radical neck dissection better.

关 键 词：分化型甲状腺癌 淋巴结转移 简化甲状腺癌改良根治术 

分 类 号：R736.1[医药卫生—肿瘤]