颈部低位领式切口行甲状腺癌择区性颈清扫的临床应用  

Clinical application of a selected neck dissection through a low-collar incision in thyroid carcinoma

作　　者：刘军[1] 苏磊[2] 桑剑锋[2] 庄晓明[2] 姚永忠[2] 

机构地区：[1]东南大学医学院,江苏南京210009 [2]南京大学医学院附属鼓楼医院普通外科,江苏南京210008

出　　处：《东南大学学报（医学版）》2015年第4期572-576,共5页Journal of Southeast University(Medical Science Edition)

基　　金：江苏省普通高校研究生科研创新计划项目(SJLX_0104)

摘　　要：目的:总结颈部低位领式切口行甲状腺癌择区性颈清扫的临床应用。方法:搜集2009年1月至2014年9月在我科行低位领式切口下甲状腺全叶切除术加择区性颈淋巴结清扫术的160例甲状腺乳头状癌患者及同期在"L"形切口下行甲状腺癌功能性颈淋巴结清扫术的42例甲状腺乳头状癌患者,回顾性分析其临床病理资料。结果:202例患者中央区淋巴结转移率为71.3%,颈侧区淋巴结转移率为54.5%,跳跃性转移率为5.94%。与传统的"L"形切口功能性颈淋巴结清扫术相比,采用颈部低位领式切口行择区性淋巴结清扫术具有切口小、手术时间短、颈部感觉障碍发生率低、美观度高等特点,但总的住院日、术后常见并发症的发生率、清扫的淋巴结个数及复发率差异无统计学意义(P>0.05)。颈侧区淋巴结转移与患者的性别、年龄、中央区淋巴结状况、被膜侵犯、肿块最大直径、病灶单发或多发相关(P<0.05)。结论:对于临床怀疑或影像学提示颈侧区淋巴结转移的,尤其是对于年龄小于45岁的男性、B超肿块最大径大于2 cm的多发灶、术中探查发现包膜受侵犯的c N0甲状腺乳头状癌患者,建议在清扫中央区淋巴结的基础上加行颈侧区淋巴结清扫。选择低位领式切口在肿瘤根治的基础上兼顾了功能外观,尤其是在无广泛淋巴结转移(Ⅱb、Ⅴa区转移)的情况下是一种安全而合理的术式。Objective： To generalize clinical application of a selected neck dissection through a low-collar incision in papillary thyroid carcinoma（ PTC）. Methods： We retrospectively analyzed clinical-pathology data of 160 PTC cases who underwent total thyroidectomy with a selected neck dissection through a low-collar incision and 42 PTC cases who underwent functional cervical dissection through L-form incision in our department from January,2009 to September,2014. Results： In 202 cases,metastatic rate of lymph node in neck central area was 71. 3% while the lateral compartment was 54. 5% and skipping metastasis was 5. 94%. Smaller incision,shorter surgery time,minimal trauma,more cosmetic were the advantages of a selected neck dissection through a low-collar incision,but the results showed no differences in total hospitalization period,incidence of common complications,number of dissected lymph nodes and recurrence rate（ P〉0. 05）. The lateral compartment lymph nodes metastasis was related to sex,age,neck central area metastasis,capsular invasion,maximal diameter and mulifocality in two groups（ P〈0. 05）. Conclusion： In thyroid carcinoma patients with clinically suspicious or radiographic suggested lateral cervical lymph node metastasis,especially for the c N0 patients who were male younger than 45 years old,larger or equal to 2. 0 centimeter in max ultrasound diameter, neck central area metastasis, mulifocality or capsular invasion,it is suggested to take lateral compartment lymph nodes dissection. If the patients had no extensive cervical lymph node metastasis（ level Ⅱ b and Ⅴ a） and invasion,a selective cervical node dissection through a low-collar incision is a safe and reasonable choice.

关 键 词：甲状腺肿瘤 低位领式切口颈淋巴结清扫 颈侧区淋巴结 危险因素 

分 类 号：R736.1[医药卫生—肿瘤] R730.57[医药卫生—临床医学]