摘要
目的 探讨改良内镜辅助甲状腺切除术（Miccoli手术）用于甲状腺乳头状癌颈侧区淋巴结清扫术的可行性、安全性及肿瘤根治性.方法 回顾性分析2013年1月至2015年9月在浙江大学医学院附属邵逸夫医院头颈外科接受改良Miccoli手术颈侧区淋巴结清扫术治疗的连续130例甲状腺乳头状癌伴颈侧区淋巴结转移患者的临床资料.男性31例,女性99例,年龄15～70岁,平均年龄（39±11）岁.甲状腺切除术及中央区淋巴结清扫术在直视或内镜辅助下完成,颈侧区淋巴结清扫术均在内镜辅助下完成.术后每6个月检测甲状腺功能、甲状腺球蛋白抗体、甲状腺球蛋白,同时行甲状腺床区及侧颈区超声检查,随访截至2016年3月31日.结果 130例患者中,1例中转开放手术,129例在内镜下顺利完成手术.内镜辅助颈侧区淋巴结清扫术手术时间（74±17）min,术后住院时间（4.9±2.1）d.甲状腺原发灶最大径（1.3±0.7）cm,颈侧区淋巴结清扫数目（42±13）枚.术后发生暂时性低钙血症19例,无永久性低钙血症,暂时性喉返神经损伤7例,永久性喉返神经损伤3例（2例因肿瘤侵犯切除）.颈侧区淋巴结清扫相关并发症包括暂时性副神经损伤2例,暂时性面神经下颌缘支损伤1例,术后出血1例,乳糜漏4例.术后随访（19±10）个月,血清甲状腺球蛋白平均浓度0.10μg/L,所有病例未见肿瘤残留或复发.结论 改良Miccoli手术颈侧区淋巴结清扫术治疗甲状腺乳头状癌安全可靠,手术清扫彻底、切口小,有临床应用价值.
Objective To discuss the feasibility,safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection （MIVALND） for papillary thyroid carcinoma.Methods Data of 130 patients from Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Medical School,Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively.There were 31 male and 99 female patients with the mean age of （39± 11） years.The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted （VA） approach,lateral neck dissection was performed via the VA approach.Serum thyroglobulin and thyroglobulin antibody levels were measured every 6 months after surgery.Ulrasonography was performed to assess the thyroid bed and lateral neck compartment every 6 months after surgery.The mean operation time for MIVALND,mean postoperative hospital stay,size of primary tumor,number of retrieved lymph nodes,complication rates,and postoperative serum thyroglobulin levels were analyzed retrospectively.The patients were followed up by outpatient review and until March 2016.Results Beside 1 case was converted to open procedure,129 （99.2%） patients successfully underwent MIVALND.The mean operative time was （74±17） min （ranging from 40 to 120 rin） for MIVALND.The mean postoperative hospital stay was （4.9±2.1） days （range 2 to 14 days）.The mean size of primary tumor was （1.3±0.7） cm （range 0.3 to 4.0 cm）.The mean number of lymph nodes removed was 42± 13 （range 15 to 79） in lateral compartment.Postoperative complications included 19 transient hypoparathyroidism,7 transient recurrent laryngeal nerve （RLN） palsy and 3 permanent RLN palsy （tumor invasion and the RLN was resected en bloc with the tumor in 2 cases）,2 （1.5%） transient palsy of spinal accessory nerve,1 （0.8%） transient palsy of marginal mandibular branch of the facial nerve,1 （0.8%） seroma,and 4 （3.1%） minor chyle leak.The mean follow-up period was （19：±10） months （ranged 6 to 36 months）.The mean serum thyroglobulin level was 0.10 μg/L during follow-up.No evidence of local residual or recurrent disease was observed at postoperative follow-up.Conclusion The modified MIVALND is a safe and feasible approach in selected papillary thyroid carcinoma patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2016年第11期864-869,共6页
Chinese Journal of Surgery
