经胸经口联合入路腔镜甲状腺癌颈侧区淋巴结清扫术临床应用  

Application of endoscopic thyroidectomy plus lateral neck dissection via breast approach combined with transoral approach

作　　者：王源源 吴国洋[2] 罗晔哲[2] 林福生[2] 高丹阳[3] WANG Yuanyuan;WU Guoyang;LUO Yezhe;LIN Fusheng;GAO Danyang(The Second Department of Thyroid Surgery,Zhengzhou University First Affiliated Hospital.Zhengzhou,450000,China;Department of General Surgery,Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,China;Department of Thyroid and Breast Surgery,Shishi Hospital,Shishi,Fujian 362700,China)

机构地区：[1]郑州大学第一附属医院甲状腺外二科,河南郑州450000 [2]厦门大学附属中山医院普通外科,福建厦门361004 [3]福建省石狮市医院甲乳外科,福建石狮362700

出　　处：《中国普通外科杂志》2022年第11期1437-1444,共8页China Journal of General Surgery

摘　　要：背景与目的:目前,经胸乳入路腔镜甲状腺癌手术已广泛开展,但伴颈侧区淋巴结转移的患者能否在腔镜下完成彻底的淋巴结清扫,特别是Ⅵ和Ⅳ区的低位淋巴结清扫,一直存在争议。本研究总结分析笔者团队近年实施的经胸经口联合入路腔镜甲状腺癌的颈侧区淋巴结清扫患者的临床资料,探索采用该术式的必要性及安全性。方法:回顾分析2015年2月—2021年12月于厦门大学附属中山医院63例行腔镜甲状腺切除、中央区及颈侧区淋巴结清扫的甲状腺乳头状癌患者资料。其中,41例行经胸口联合入路手术(联合入路组),包括12例行经胸甲状腺切除、中央区及颈侧区淋巴结清扫后再经口补充清扫Ⅵ和Ⅳ区淋巴结,另29例行经胸和经口手术步骤合理融合,不再单独补充清扫Ⅵ及Ⅳ区淋巴结;22例行单纯经胸入路腔镜甲状腺癌根治并颈侧区淋巴结清扫术(经胸入路组)。比较两组患者的相关临床指标。结果:两组患者的年龄、性别及肿瘤大小差异均无统计学意义(均P>0.05)。联合入路组的12例经口补充清扫颈侧区淋巴结的标本中有8例检出淋巴结,其中2例检出阳性淋巴结。联合入路组与经胸入路组获得的中央区淋巴结总数分别为(8.80±5.78)枚、(8.23±3.53)枚,颈侧区获得的淋巴结总数分别为(31.49±14.90)枚、(29.05±7.80)枚,差异均无统计学意义(P>0.05)。两组的手术时间、住院时间以及术后出血、喉返神经麻痹、甲状旁腺功能减低、副神经损伤、乳糜漏和Horner综合征等并发症发生率差异均无统计学意义(均P>0.05)。术后随访,联合入路组1例颈侧区淋巴结转移癌复发,经胸入路组1例手术清扫侧中央区淋巴结转移癌复发。结论:经胸经口联合入路腔镜甲状腺癌颈侧区淋巴结清扫术安全、有效,与单纯经胸入路疗效相当。但补充清扫中的阳性淋巴结提示,对于淋巴结转移较多的甲状腺癌患者经胸经�Background and Aims:Endoscopic thyroid cancer surgery via breast approach has been widely carried out.However,whether a thorough lymph node dissection,especially the dissection of the lower neck levelⅥandⅣlymph nodes,can be completed under the endoscope in patients with lateral neck lymph node metastasis remains controversial.This study was conducted to summarize and analyze the clinical data of patients undergoing endoscopic thyroidectomy plus lateral cervical lymph node dissection via breast approach combined with transoral approach performed by the author's team to investigate the necessity and safety of adopting this procedure.Methods:The data of 63 patients with papillary thyroid cancer undergoing endoscopic thyroidectomy plus central and lateral neck dissection in Zhongshan Hospital of Xiamen University from February 2015 to December 2021 were reviewed.Of the patients,41 cases underwent endoscopic central and lateral neck dissection via breast approach combined with transoral approach(combined approach group),including 12 cases undergoing complementary level VI and IV lymph node dissection via transoral approach after thyroidectomy plus central and lateral neck dissection via breast approach,and the other 29 cases undergoing appropriate integration of surgical procedures via both breast and transoral approaches,without additional complementary levelⅥandⅣlymph node dissection;22 cases underwent endoscopic thyroidectomy and lateral neck dissection via breast approach alone(breast approach group).The main clinical variables were compared between the two groups of patients.Results:There were no differences in age,sex,and tumor size between the two groups of patients(all P>0.05).Lymph nodes were detected in the specimens of 8 cases among the 12 patients undergoing complementary lymph node dissection in the combined approach group.Positive lymph nodes were found in 2 of them.In combined approach group and breast approach group,the total numbers of central compartment lymph nodes obtained were 8.80±5.78 a

关 键 词：甲状腺癌 乳头状 淋巴转移 甲状腺切除术 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]