完全腔镜下颈侧区清扫术  

Totally Laparoscopic Radical Neck Dissection

作　　者：王平[1] 王勇[1] 

机构地区：[1]浙江大学医学院附属第二医院甲状腺外科,杭州310009

出　　处：《中华普外科手术学杂志（电子版）》2013年第4期23-23,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81000184);浙江省自然科学基金资助项目(Y2110367)

摘　　要：完全内镜下颈侧区淋巴结清扫需根据术前的影像学检查结果及其肿瘤的位置,结合术中清扫淋巴结的冰冻切片病理学检查结果,选择性清扫Ⅲ区、Ⅳ区及部分ⅤB区,或者加ⅡA区。采用胸锁乳突肌的肌间入路清扫外侧Ⅲ区和Ⅳ区淋巴结,常规切断肩胛舌骨肌,沿颈内静脉进行清扫。清扫ⅡA区的入路同开放手术,即胸锁乳突肌与带状肌之间的入路。空间扩大要按需进行,即边清扫边扩大空间,根据需要合适地向上、向外扩大。合理选择病例,完全内镜下颈侧区淋巴结清扫既安全可行,又具备显著美容效果。For total endoscopic thyroidectomy, selective lymphadenectomy of levels Ⅲ, Ⅳand VB with or without ⅡA should be performed according to the tumor location, preoperative radiological and intraoperative pathological results. Lymphadenectomy of levels Ⅲand IV is done along the internal jugular vein, using the intramuscular approach with retraction of the sternocleidomastoid muscle and cutting-off of the omohyoid muscle. Lymphadenectomy of level ⅡA, which is similar to a traditional open surgery, is performed through the space between the sternocleidomastoid and strap muscles. A larger operative space could be created upward or outward on demand. SET is a safe, effective procedure with excellent cosmetic results in selective cases.

关 键 词：甲状腺肿瘤 腹腔镜检查 颈淋巴结清扫 

分 类 号：R730.5[医药卫生—肿瘤]