颈部两切口在保留颈丛皮神经颈淋巴结清扫术中的应用  

Application of two short dermatoglyphic incision in neck dissection of differentiated thyroid carcinoma with reservation of cervical plexus cutaneous nerve

作　　者：耿中利[1] 董朝[1] 任光辉[1] 阿力比亚提.艾尼 单美慧[1] 李鸿涛[1] 马斌林[1] 

机构地区：[1]新疆医科大学附属肿瘤医院乳腺头颈外科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2012年第7期962-966,共5页Journal of Xinjiang Medical University

基　　金：乌鲁木齐市科学技术计划项目(Y09231001)

摘　　要：目的探讨分化型甲状腺癌颈淋巴结清扫术的手术入路。方法回顾性分析2008年12月-2011年7月新疆医科大学附属肿瘤医院乳腺头颈外科进行保留颈丛皮神经颈淋巴结清扫术(即保留颈丛皮神经的Ⅱ、Ⅲ、Ⅳ、Ⅵ区清扫)的58分化型甲状腺癌患者临床资料,其中26例采用颈部两切口(两切口组),32例采用颈部"L"型切口(传统"L"型切口组)分别进行颈淋巴结清扫,所有患者均由同一组手术人员完成。并对两组患者手术效果、手术时间、出血量、有无皮瓣坏死、颈部有无积液、颈部水肿程度、瘢痕程度及功能障碍等与手术相关的并发症进行对比。结果两切口组26例甲状腺癌患者手术均顺利完成,无一例需改用其他方式颈淋巴结清扫,与传统"L"型切口组比较,手术时间、出血量、颈部淋巴漏未见增多,皮瓣坏死、颈部水肿程度、瘢痕程度及功能障碍明显减少。术后随访1.5～31个月未出现局部及颈部淋巴结复发。结论颈部两切口颈淋巴结清扫术不增加相关并发症,其在不影响颈淋巴结清扫效果的同时又兼顾了功能与美容,是甲状腺癌保留颈丛皮神经的Ⅱ、Ⅲ、Ⅳ、Ⅵ区域淋巴结清扫的一种较为理想的手术入路。Objective To investigate the incision approaches to dissect neck lymphonodes in differentiated thyroid carcinoma. Methods Retrospectively analyzed the clinical data of 58 cases of patients with differ entiated thyroid carcinoma, who were hospitized in Affiliated Tumour Hospital of Xiniiang Medical Uni versity from October 2007 to April 2009 and received neck dissection with cervical plexus reserved （retaining the cervical plexus cutaneous nerve Ⅱ、Ⅲ、Ⅳ、Ⅵ districts）. Among which 26 cases were operated by two short dermatoglyphic incision and 32 cases were operated by one ＂L＂ incision. The operation duration, blood loss, skin flap necrosis, edema degree, scar formation and disfunction between the two groups were compared. Results The operation of 32 cases with two-short-dermatoglyphic incision were all successfully completed, none of which had changed the incision. The operation duration, blood loss and lymphatic leakage had not increased, whereas the incidence of skin necrosis, disfunction, degree of edema and scar decreased significantly. After 1.5 to 31 months＇follow-up, no recurrence and lymphonode malignance were found. Conclusion Two-short-dermatoglyphic incision of neck dissection did not increase related complica tions. It is an ideal approach to reserve cervical plexus in neck dissection of thyroid carcinoma, for taking good care of function and beauty while not decrease the therapeutic effects.

关 键 词：分化型甲状腺癌 颈部两切口颈淋巴结清扫术 淋巴结清扫 

分 类 号：R739.91[医药卫生—肿瘤]