中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (05): 411-413.

• 论著 • 上一篇    下一篇

领式切口保留颈丛择区性颈部淋巴结清扫术治疗分化型甲状腺癌112例分析

孙团起，吴    毅   

  1. 复旦大学附属肿瘤医院头颈外科  复旦大学上海医学院肿瘤学系，上海 200032
  • 出版日期:2011-05-01 发布日期:2011-05-30

  • Online:2011-05-01 Published:2011-05-30

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摘要：

目的    总结领式切口保留颈丛的择区性颈部淋巴结清扫术在分化型甲状腺癌中的应用和经验。方法  复旦大学附属肿瘤医院头颈外科2009年1月至2010年12月期间对112例临床考虑颈侧区转移（CN1b）甲状腺癌病人在原发灶根治的同时施行了领式切口保留颈丛的择区性颈部淋巴结清扫术。 结果    颈部淋巴结转移主要分布在Ⅵ区（78.8%）、Ⅳ区（72.9%）、Ⅲ区（60.2%）、Ⅱ区（43.8%）和ⅤB区（16.9%）。病人术后均无明显耳部、下颈部和肩部感觉异常。术后经1～25个月随访无局部复发。结论    对于临床考虑颈侧区转移（CN1b）或穿刺证实颈侧区转移的分化型甲状腺癌，在没有ⅤA区转移或没有淋巴结明显外侵的首次手术病人，领式切口保留颈丛的择区性颈清扫可以作为替代根治性或改良性颈清扫的一种选择。

关键词: 甲状腺肿瘤, 颈清扫, 颈丛

Abstract:

Preservation of the cervical plexus with a selective neck dissection through a low-collar incision in patients with differentiated thyroid carcinoma: an analysis of 112cases        SUN Tuan-qi, WU Yi. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC)；Department of Oncology, Shanghai Medical College of Fudan University, Shanghai200032, China
Corresponding author: WU Yi, E-mail: ywu@rddb.shanghai.gov.cn
Abstract    Objective    To determine the utility and experiences of preserving the cervical plexus in selective neck dissections for differentiated thyroid carcinoma (DTC). Methods    Preservation of the cervical plexus was used for selective neck dissection through a low-collar incision in 112 cases of  DTC from January 2009 to December 2010 in the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center. Results    The most common site of cervical lymph node metastases was level VI (78.8%), followed by level IV (72.9%) and III (60.2%). The metastasis rates in level II and VB were 43.8% and 16.9%, respectively. No impairment of sensation of ears, lower necks and upper shoulders was found. There was no local recurrence at the time of follow-up for 1 to 25 months. Conclusion    If utilized in the appropriate patient population, a selective neck dissection through a low-collar incision for DTC can be a successful alternative to the modified or radical neck dissection. It could be performed in N1b patients when there is no level VA lymph node metastasis, or when the metastasis is not aggressive.

Key words: thyroid carcinoma, neck dissection, cervical plexus