腔镜手术治疗颈侧区淋巴结大于2 cm的甲状腺癌的临床研究  

Clinical study of endoscopic thyroid surgery in the treatment of lateral lymph node larger than 2 cm

作　　者：王源源 吴国洋[2] 罗晔哲[2] 林福生[2] 严朝龙 WANG Yuan-yuan;WU Guo-yang;LUO Ye-zhe(Department of the Second Thyroid Surgery,Zhengzhou University First Affiliated Hospital,Zhengzhou 450000,China;Department of General Surgery,Zhongshan Hospital,Xiamen University)

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

出　　处：《腹腔镜外科杂志》2023年第3期191-194,203,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经胸、经口联合入路行腔镜甲状腺癌根治术治疗颈侧区转移淋巴结>2 cm病例的可行性及安全性,以期为腔镜甲状腺手术专家共识中适应证的拓展提供参考。方法:回顾分析2020年5月至2022年4月行腔镜颈侧区淋巴结清扫术的甲状腺乳头状癌患者的临床资料,选择转移淋巴结有融合或淋巴结直径>2 cm的9例进行分析。9例患者均经胸、经口联合入路行腔镜甲状腺切除与中央区、颈侧区淋巴结清扫术。结果:9例患者均成功完成双侧甲状腺全切除术,5例行双侧中央区淋巴结清扫,2例行双侧颈侧区淋巴结清扫。术后出现1例短暂喉返神经麻痹、1例永久性喉返神经麻痹、2例短暂甲状旁腺功能减低、1例副神经损伤、1例乳糜瘘。随访至目前,尚无手术创面区域或淋巴结复发。结论:在一定的腔镜手术经验基础上,腔镜甲状腺癌颈侧区淋巴结清扫术治疗颈侧区转移淋巴结超过2 cm的甲状腺癌是安全、可行的,经胸经口联合入路腔镜甲状腺切除+中央区、颈侧区淋巴结清扫术是较好的手术方法。Objective:To investigate the feasibility and safety of endoscopic radical resection via breast approach combined with oral approach for thyroid cancer with metastatic lateral lymph node larger than 2 cm,in order to provide the evidence for the indication development of the consensus related to the endoscopic thyroid surgery.Methods:Medical records of thyroid papillary carcinoma patients who underwent endoscopic lateral neck dissection from May 2020 to Apr.2022 were retrospectively reviewed.9 patients whose metastatic lateral lymph node were fused or larger than 2 cm were selected and underwent endoscopic thyroidectomy,lymph node dissection in the central neck region and lateral neck region via breast approach combined with oral approach.Results:All of 9 patients successfully underwent bilateral total thyroidectomy,5 patients were operated with left and right central lymph node dissection,and 2 patients were operated with bilateral lymph node dissection.For the surgical complication,there was transient recurrent laryngeal nerve paralysis in 1 case,permanent recurrent laryngeal nerve paralysis in 1 case,transient hypocalcemia in 2 cases,injury of accessory nerve in 1 case and chyle leak in 1 case.Postoperative follow-up revealed that no patient had recurrence in lymph node or operation bed.Conclusions:It is feasible and safe to do endoscopic lymph node dissection in the lateral neck region in some thyroid cancer patients with metastatic lateral lymph node larger than 2 cm based on experienced surgical team.Endoscopic thyroidectomy including lymph node dissection in the central neck region and lateral neck region via breast approach combined with oral approach would be a good selection.

关 键 词：甲状腺肿瘤 甲状腺切除术 内窥镜检查 颈淋巴结清扫术 

分 类 号：R653[医药卫生—外科学]