免充气腔镜辅助下侧颈区淋巴结清扫术在老年甲状腺癌患者中的应用  

Application of non inflatable endoscopic assisted lateral cervical lymph node dissection in elderly patients with thyroid cancer

作　　者：秦瑞浩 马利娜 奚海林[1] 赵浩[1] 冯苏[1] QIN Ruihao;MA Lina;XI Hailin;ZHAO Hao;FENG Su(Department of Thyroid Surgery,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,P.R.China;Department of Thoracic Surgery,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,P.R.China)

机构地区：[1]徐州市中心医院甲状腺外科,江苏徐州221009 [2]徐州市中心医院胸外科,江苏徐州221009

出　　处：《中国普外基础与临床杂志》2022年第6期779-782,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：江苏省“双创博士”课题(项目编号:ZXYYSCBS201710)。

摘　　要：目的探讨免充气腔镜辅助下侧颈区淋巴结清扫术在老年甲状腺癌患者中的应用效果。方法回顾性总结2016年1月至2020年12月期间笔者所在团队实施免充气腔镜辅助下侧颈区淋巴结清扫术61例患者的临床资料。女48例,男13例;年龄65~82岁、(71±6.5)岁。统计手术时间、术中出血量、副神经损伤例数、膈神经损伤例数、侧颈区清扫淋巴结总数、术后淋巴漏发生情况,术后引流量和住院时间。随访时行颈部超声检查并测定甲状腺球蛋白水平以评估复发情况。结果所有患者均顺利完成免充气腔镜辅助下侧颈区淋巴结清扫术,手术时间为51~117 min、(92±22.1)min,术中出血量为80~150 mL、(120±17.1)m L,术后引流量为190~670 mL、(332±167.1)mL,术后住院时间为5~13 d、(9±2.3)d,清扫淋巴结总数为11~23个、(16±4.7)个。术后发生甲状旁腺功能减退11例,暂时性喉返神经损伤5例,无膈神经损伤病例,副神经损伤3例。术后1例患者拔除引流管后出现切口局部红肿。发生淋巴漏3例。随访期间无肿瘤复发病例。结论免充气腔镜辅助下侧颈区淋巴结清扫术为老年甲状腺癌患者淋巴清扫提供了技术支持,效果确切,短中期随访结果满意。Objective To investigate the clinical effect of non inflatable endoscope assisted lateral cervical lymph node dissection in elderly patients with thyroid cancer.Methods The clinical data of 61 patients with lateral cervical lymphadenectomy assisted by non inflatable endoscope from January 2016 to December 2020 were retrospectively summarized.There were 48 females and 13 males with an average age of(71±6.5)years(range,65–82 years).The operative time,intraoperative blood loss,cases of accessory nerve injury,cases of phrenic nerve injury,total number of lateral neck dissection lymph nodes,postoperative lymphatic leakage,postoperative drainage volume and hospital stay were counted.Neck ultrasonography and thyroglobulin levels were measured during follow-up to assess recurrence.Results All patients successfully completed the non inflatable endoscopic assisted lateral cervical lymph node dissection,the operative time was 51–117 min,the average was(92±22.1)min,the intraoperative blood loss was about80–150 mL,the average was(120±17.1)mL,the postoperative drainage was 190–670 mL,the average was(332±167.1)mL,the postoperative hospital stay was 5–13 d,the average was(9±2.3)d,the total number of lymph nodes was 11–23,the average was(16±4.7).There were 11 cases of hypoparathyroidism,5 cases of temporary recurrent laryngeal nerve injury,3 cases of accessory nerve injury and no case of phrenic nerve injury.One patient had local redness and swelling after removing the drainage tube.Lymphatic leakage occurred in 3 cases.There was no recurrence during the follow-up period.Conclusion Non inflatable endoscope assisted lateral neck lymph node dissection provides technical support for elderly patients with thyroid cancer,and the effect is exact,and the short and medium-term follow-up results are satisfactory.

关 键 词：甲状腺癌 免充气腔镜手术 侧颈区淋巴结清扫 老年患者 

分 类 号：R736.1[医药卫生—肿瘤]