内镜颈清术与传统颈清术治疗cN0甲状腺乳头状癌的比较  

Comparative study between endoscopic neck dissection and traditional neck dissection in treatment of cN0 papillary thyroid carcinoma

作　　者：洪云 黄晓明[2] 冯鉴伦 曹海玲 曹余彦 黎颂铭 

机构地区：[1]番禺区中心医院甲状腺乳腺外科,广州511400 [2]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科,510120

出　　处：《岭南现代临床外科》2014年第4期387-390,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省医学科研基金资助(编号:A2012560);中山大学临床医学研究5010计划项目(编号:2010008)

摘　　要：目的 研究胸前及耳后颈部联合切口（改良双平行切口）无注气内镜辅助下行颈部淋巴结阴性（cN0）甲状腺乳头状癌颈清术的可行性.方法 选择45例经胸前内镜治疗的cN0甲状腺乳头状癌患者,其中11例Ⅵ区淋巴结病理阳性者,行内镜辅助下经改良双平行小切口选择性颈淋巴结清扫术（内镜组）.就手术时间、术中出血量、Ⅱ～Ⅳ区淋巴数量以及阳性率、手术并发症等指标进行分析.并与同期11例传统颈清术治疗cN0甲状腺乳头状癌（传统组）结果进行比较.结果 内镜组手术时间为218.16±31.54 min,与传统组202.35±28.81 min,差异无统计学意义（t=1.227,P=0.233）;内镜组手术出血量（52.42±13.25 mL）,与传统组（64.27±15.57 mL）差异无统计学意义（t=1.922,P=0.068）;清扫Ⅱ～Ⅳ区淋巴数量,内镜组（15.37±4.61枚）与传统组（16.19±5.23枚）差异无统计学意义（t=0.390,P=0.700）;清扫Ⅱ～Ⅳ区淋巴结阳性数量,内镜组（2.82±0.34枚）与传统组（3.15±0.46枚）差异无统计学意义（t=1.913,P=0.070）.术后内镜组发生暂时性声嘶1例,暂时性手足麻木两组各1例,传统组出现淋巴漏1例,两组并发症发生率的差异无统计学意义（x^2=2.000,P=0.367）.结论 采用该手术入路在内镜辅助下行cN0甲状腺乳头状癌颈淋巴结清扫术是可行和安全有效的.Objective To investigate the feasibility of gasless endoscope-assisted neck dissection via the anterior chest wall and the ear-behind neck incision （the improved dual parallel incision） in cNO papillary thyroid carcinoma （PCT）. Methods Forth-five patients with cNO PCT underwent endoscopic neck dissection, including l 1 patients with pathological lymph node metastasis at level VI （endoscopic group）. Meanwhile, another 11 patients with cN0 PCT underwent traditional neck dissection （traditional group）. Operation time, estimated intraoperative blood loss, lymph node number at level II-IV and their metastasis number, complications were compared between the two groups. Results Operation time was no difference （t=1.227, P=0.233） between endoscopic group （218.16±31.54 rain） and traditional group （202.35±28.81 min）. There was no difference （t = 1.922, P=0.068 ） in intraoperative blood loss between endoscopic group （52.42±13.25 mL） and traditional group （64.27±15.57 mL）. Lymph node number at level II-IV and their metastasis number were also no difference （t=0.390,P= 0.700 and t=1.913, P=0.070） in endoscopic group （15.37±4.61 and 2.82±0.34） and traditional group （16.19±5.23 and 3.15±0.46）. There were one case of transient hoarseness in endoscopic group and one of lymphorrhagia in traditional group, and one of transient hypocalcemia in both groups. No difference was observed in complication occurrence between two groups. （x^2=2.000, P=0.367）. Coneulsion Endoscopic neck dissection in cN0 papillary thyroid carcinoma is safe and feasible.

关 键 词：内镜 电视辅助手术 甲状腺乳头状癌 淋巴结清扫术 

分 类 号：R616[医药卫生—外科学] R736.1[医药卫生—临床医学]