摘要
目的:探讨腔镜辅助改良Miccoli术式在甲状腺癌颈侧区淋巴结清扫中的安全性及美容优势。方法:为25例甲状腺乳头状癌患者行腔镜辅助下Ⅱ、Ⅲ、Ⅳ、Ⅴ区颈侧淋巴结清扫术。术中应用自制拉钩建腔。手术路径不同于传统的颈清,在颈深筋膜浅层与深层(椎前筋膜)之间的颈深筋膜中层(颈内脏筋膜)操作。结果:25例手术均获成功,效果满意。颈部切口4~5cm,手术时间平均(183.60±25.92)min,清扫Ⅱ、Ⅲ~Ⅳ、Ⅴ区淋巴结平均(5.64±3.53)、(9.00±3.48)、(6.68±5.00)枚,住院费用平均(15929.53±4126.43)元。术后发生乳糜瘘4例,面部水肿2例。结论:腔镜辅助改良Miccoli术式微创、安全、美容效果优势明显,清扫层次不同于传统术式,值得进一步探索。
Objective:To study the safety and cosmetic advantage of endoscopic-assisted improved Miccoli lateral neck dissection for thyroid carcinoma.Methods:Twenty-five patients who suffered from papillary thyroid carcinoma underwent endoscopic-assisted lateral neck dissection of Ⅱ,Ⅲ,Ⅳ,Ⅴ region.Self-made retractors were used to build a cavity during surgery.Different from the traditional operation, this operation was working between superficial and deep layer of deep cervical fascia ( prevertebral fascia),which was the middle layer of deep cervical fascia ( cervical visceral fascia).Results:All of the 25 operations were successful with satisfactory effect.The neck incision was 4-5 cm,the operation time was ( 183.60±25.92) min,the number of lymph node in Ⅱ,Ⅲ-Ⅳ,Ⅴregion were ( 5.64±3.53),( 9.00± 3.48) and( 6.68±5.00),the hospitalization cost was ( 15 929.53±4 126.43) yuan.Chylous fistula was found in 4 cases and facial edema occurred in 2 cases after operation.Conclusions:The minimally invasive,safe and cosmetic advantages of endoscopic-assisted improved Miccoli are obvious,and the dissection layer is different from the traditional surgery,this procedure deserves further exploration.
作者
王康伟
王永
张浩
金功圣
WANG Kangwei;WANG Yong;ZHANG Hao(Department of Surgical Oncology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)
出处
《腹腔镜外科杂志》
2019年第6期401-404,共4页
Journal of Laparoscopic Surgery
