中国实用外科杂志

中国实用外科杂志

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甲状腺乳头状癌颈侧区淋巴结清扫术后再手术分析

吕承洲1，刘文波2，董文武1，张大林1，张    挺1，邵    亮1，贺    亮1，王志宏1，张    平1，张    浩1   

  1. 1中国医科大学附属第一医院甲状腺外科，辽宁沈阳 110001；2菏泽市立医院，山东菏泽 274031
  • 出版日期:2019-07-01 发布日期:2019-07-10

  • Online:2019-07-01 Published:2019-07-10

摘要：

目的    探讨甲状腺乳头状癌颈侧区淋巴结清扫术后再手术的原因及预防措施。方法    回顾性分析2013年1月至2017年12月中国医科大学附属第一医院收治的颈侧区再手术的31例甲状腺乳头状癌病人的临床资料，分析淋巴结清扫情况。结果    31例既往接受手术1～3次不等，其中17例颈侧区淋巴结清扫范围记述不明。术后12个月以内发现淋巴结异常有24例（77.4%），12个月后发现为7例。再手术前颈侧区淋巴结CT影像学诊断中，Ⅳ区的阳性率为58.1%，Ⅱ区（颈内静脉外缘以外）为41.9%，颈动脉三角区域、Ⅲ区（颈内静脉外缘以外）均为22.6%，胸锁乳突肌、胸骨舌骨肌肌间为12.9%。术后病理学诊断各分区的淋巴结转移发生率分别为：Ⅱ区64.0%，Ⅲ区81.8%，Ⅳ区68.4%，Ⅴb区8.3%，胸锁乳突肌、胸骨舌骨肌肌间13.6%。结论    颈侧区淋巴结清扫术前重视易复发淋巴结区域的影像学评估，术中进行规范的操作，可减少再手术的发生。

关键词: 甲状腺乳头状癌, 颈淋巴结清扫术, 再手术

Abstract:

Analysis of lateral neck lymph node reoperation in papillary thyroid carcinoma        LYU Cheng-zhou*，LIU Wen-bo，DONG Wen-wu，et al. *Department of Thyroid Surgery，the First Affiliated Hospital of China Medical University，Shenyang 110001，China
Corresponding author：ZHANG Hao，E-mail：haozhang@cmu.edu.cn
Abstract    Objective    To explore the clinical characteristics，and discuss the prevention of lateral neck lymph node reoperation. Methods    The clinical data of 31 cases of lateral neck lymph node reoperation performed between January 2013 and December 2017 in the First Affiliated Hospital of China Medical University were analyed retrospectively. Results    All 31 patients accepted 1 to 3 times lateral neck lymph node dissection，but the extent of lymph node dissection was not described enough clear in 17 cases. Twenty-four of 31 cases were found within 12 months from last operation to abnormal lymph nodes. In imaging diagnosis，the rate of metastasis in level Ⅳ was 58.1%，level Ⅱ（outside the outer edge of internal jugular vein）was 41.9%，trigonum caroticum and level Ⅲ（outside the outer edge of internal jugular vein） were 22.6%，lymph node between sternocleidomastoid and sternohyoid muscle（LNSS） was 12.9%. In pathology after surgery the rate of metastasis at levels Ⅱ，Ⅲ，Ⅳ，Ⅴb，LNSS was 64.0%，81.8%，68.4%，8.3%，13.6% respectively. Conclusion    The imaging assessment has significant effects on lateral neck lymph node dissection，within standardized procedure in surgery，which should help reduce the reoperation caused by human factor.

Key words: papillary thyroid cancer, neck lymph node dissection, reoperation