经胸前人路内镜辅助下择区性颈清扫术治疗N1b甲状腺乳头状癌  

Gasless endoscopic selective lateral neck dissection via an anterior chest approach for papillary thyroid carcinomas

作　　者：林沛亮 梁发雅[1] 韩萍[1] 陈仁辉[1] 余诗桐 蔡谦[1] 黄晓明[1] Lin Peiliang;Liang Faya;Han Ping;Chen Renhui;Yu Shitong;Cai Qian;Huang Xiaoming(Department of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科,广州510289

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第12期915-920,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 分析并评估甲状腺乳头状癌患者经胸前人路行无注气内镜下择区性颈清扫术的安全性及有效性.方法 自2008年11月至2016年12月,18例甲状腺乳头状癌（T1-2N1 bM0）患者经胸前入路行无注气内镜下甲状腺全切除、中央区淋巴清扫及颈侧择区淋巴清扫术.结果 18例患者（男7例,女11例）均成功完成经胸前入路无注气内镜下甲状腺全切除、中央区淋巴清扫及颈部同侧Ⅱ～Ⅳ区淋巴清扫术,无中转开放手术病例.术后病理显示T1期15例,T2期3例.颈侧择区清扫时长为73 min（51～92 min）,手术总出血量61.1 ml（30 ～120 ml）,术后暂时性低钙血症1例,无其他明显并发症发生.术后3个月,超声复查未见腺体组织残留,血清甲状腺球蛋白为（0.73±0.16）ng/ml.随访时间中位数54.5个月（6～104个月）,CT、超声及甲状腺球蛋白复查未见复发征象,选择性行放射活性131I检查无阳性发现.术后3个月功能性评估,嗓音障碍指数-10量表（VHI-10）为（7.7±2.9）分,吞咽损伤评分-6为（3.5±2.1）分,颈清扫功能损伤指数为（82.5±7.3）分,手臂外展试验为（4.5±0.3）分,视觉模拟评分法评分：切口疼痛0（0 ～4）分,颈部疼痛0（0 ～2）分,美观满意度9（5 ～10）分.结论 在严格把握手术适应证的前提下,初步经验表明在甲状腺乳头状癌患者中通过胸前人路行无注气内镜下颈侧择区淋巴清扫术方法可行,安全有效,美观效果满意.Objective To assess the safety and curative effect of gasless endoscopic selective lateral neck dissection （GESLND） via an anterior chest approach for papillary thyroid carcinoma （PTC）.Methods Eighteen patients with PTC（T1-2N1bM0,size 〈 3.0 cm）,having GESLND via an anterior chest approach,were included from November 2008 to December 2016.Results GESLND via an anterior chest approach was successfully performed in all 18 PTC patients （seven male and eleven female） with 83.3% of T1 and 16.7% of T2.The mean operative time of selective lateral neck dissection was 73 min （range 51-92 min）.The mean of intraoperative bleeding was 61.1 ml （range 30-120 ml）.No major complications occurred except one transient hypoparathyroidism.No residual thyroid glands were detected on ultrasonography and thyroglobulin was （0.73 ± 0.16） ng/ml three months postoperatively.The median of follow-up was 54.5 months （range 6-104 months）.No recurrence disease was observed in any patient on ultrasonography,computer tomography,thyroglobulin or selective iodine-131 scan during the follow-up period.The cosmetic result and functional preservation was excellent,when the assessments were performed three months postoperatively.Conclusion GESLND via an anterior chest approach is feasible and safe for selected PTCs,with superior appearance.

关 键 词：甲状腺肿瘤 癌 乳头状 内窥镜检查 淋巴清扫术 

分 类 号：R736.1[医药卫生—肿瘤]