颈部低位切口用于甲状腺乳头状癌功能性颈淋巴清扫术的效果评估  

Low-collar incision for functional cervical neck dissection in patients with papillary thyroid carcinoma

作　　者：徐加杰[1] 莫康楠[1] 孙磊 姜琳[1] 兰霞斌 谭卓[1] 陈超[1] 朱秀[4] 郭振英[4] 葛明华[3] XU Jiajie;MO Kangnan;SUN Lei(Department of Head and Neck Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院头颈肿瘤外科,杭州310022 [2]杭州师范大学钱江学院医学院临床医学系 [3]浙江省肿瘤医院浙江省头颈肿瘤转化医学研究重点实验室,杭州310022 [4]浙江省肿瘤医院病理科,杭州310022

出　　处：《浙江医学》2018年第23期2529-2532,2536,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(WKJ-ZJ-1605;2015DTA003)

摘　　要：目的探讨颈部低位切口用于甲状腺乳头状癌功能性颈淋巴清扫术(保留8个功能组织)的效果。方法回顾性分析91例行功能性颈淋巴清扫术的甲状腺乳头状癌患者临床资料,其中采取颈部低位切口49例,L形切口42例,比较两种切口患者颈淋巴清扫手术情况、术后并发症及术后10年淋巴结复发情况、颈部手术瘢痕情况及10年无进展生存率。结果颈部低位切口组颈淋巴清扫时间明显长于L形切口组(P<0.05);两组患者单侧颈淋巴结清扫数、Ⅱ区淋巴结清扫数、术中出血量、单侧淋巴结转移数比较,差异均无统计学意义(均P>0.05)。颈部低位切口组术后1周耳垂区痛觉障碍、颈肩部阵发性疼痛发生率均明显低于L形切口组(均P<0.05);两组患者淋巴结复发率比较,差异无统计学意义(P>0.05)。颈部低位切口组6例患者术后3年颈部瘢痕明显,L形切口组42例患者颈部瘢痕明显;颈部低位切口组患者满意度明显高于L形切口组(P<0.05)。术后10年随访期间无病死患者,颈部低位切口组与L形切口组10年无进展生存率分别为91.8%、92.9%,差异无统计学意义(P>0.05)。结论颈部低位切口用于甲状腺乳头状癌功能性颈淋巴清扫术,并不增加术后并发症及复发率,不影响患者无进展生存,且术后颈部瘢痕平整、隐蔽,患者满意度较高。Objective To evaluate the low-collar incision for functional cervical neck dissection in patients with papillary thyroid carcinoma.Methods Clinical data of 91 patients with papillary thyroid carcinoma undergoing functional cervical neck dissection were retrospectively reviewed,including 49 cases through low-collar incision and 42 through L incision.The surgical outcomes,operation time,intraoperative blood loss,complications,cosmetic effects,and 10-year progression-free survival were compared between these two groups.Results The operation time of neck lymph node dissection in low-collar incision group was significantly longer than that in L incision group(P<0.05).There was no significant difference in the number of dissected unilateral neck lymph node,the number of dissected level II lymph node,intraoperative blood loss and the number of unilateral lymph node metastasis between the two groups(P>0.05).The incidence of pain disorder and paroxysmal pain in neck and shoulder in low-collar incision group was significantly lower than that in L incision group(P<0.05).There was no significant difference in the incidence of lymph node recurrence between the two groups(P>0.05).Six patients in low-collar incision group had obvious scar in the neck three years after operation,42 patients in the L incision group had obvious scar in the neck,and the patient satisfaction of low-collar incision group was significantly higher than that of the L incision group(P<0.05).No patients died due to papillary thyroid carcinoma during the 10-year follow-up period.The 10-year progression-free survival rates were 91.8% and 92.9% in the low-collar incision group and the L incision group,respectively(P>0.05).Conclusion The application of low-collar incision in functional cervical neck dissection for papillary thyroid cancer does not increase the incidence of complications and recurrence,does not affect the progression-free survival,while there is higher patient satisfaction since the scar in the neck is smooth and concealed after surgery.

关 键 词：颈部低位切口 甲状腺乳头状癌 功能性颈淋巴清扫术 

分 类 号：R736.1[医药卫生—肿瘤]