内镜辅助下颈清扫术治疗甲状腺乳头状癌颈淋巴转移  

Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma

作　　者：张宗敏[1] 徐震纲[1] 李正江[1] 安常明[1] 刘杰[1] 朱一鸣[1] 倪松[1] 唐平章[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所头颈外科,100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第9期712-715,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨内镜辅助下颈部小切口颈清扫术的安全性和治疗效果。方法自2010年3月至2011年5月间采用内镜辅助下小切口颈清扫术治疗甲状腺乳头状癌颈部淋巴结转移患者18例，其中男性4例，女性14例，年龄28～56岁。术前超声明确提示甲状腺肿瘤为恶性。所有手术均在全麻下进行内镜辅助下甲状腺切除和颈清扫术，其中Ⅱ～Ⅳ、Ⅵ区清扫6例，Ⅱ～Ⅵ区清扫12例。过程与常规手术相同。结果本组患者切口长度均为5cm，术后病理示T15例，T25例，136例，T42例。NO5例，N1a0例，N1b13例。本组内镜辅助手术时间为2．5～5．0h，平均3．6h。术后未发生严重并发症。平均术后伤口引流量为168ml，平均术后拔出引流管时间为4．6d，平均清扫颈部淋巴结33．1枚。所有患者经过2～3年随访未出现甲状腺局部和颈部淋巴结复发。结论颈部小切口在内镜辅助下完成侧颈部淋巴结Ⅱ～Ⅵ区清扫术安全、可靠，手术清扫彻底，术后美容效果满意。Objective Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma （PTC） leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety. Methods Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level Ⅱ～Ⅵand 12 cases of PTC at T1 - T4 with definite lymph node metastasis at level Ⅱ～Ⅴ received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level Ⅱ～Ⅵ, Ⅵ or Ⅱ～Ⅵdissection via small neck incision was performed. Results This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, Nlb 13 cases. Mean operative time for lateral neck dissection was 3.6 hours （ ranging 2. 5 - 5.0 hours ） . No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 （ ranging 16 - 61 ）. No residual or recurrent disease was found in 2 - 3 years follow-up time. Conclusion Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 内窥镜检查 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]