程序化胸乳入路腔镜颈侧区淋巴结清扫在甲状腺乳头状癌手术中应用的可行性分析

Feasibility analysis of the application of programmed process endoscopic lateral neck dissection via chest-breast approach in papillary thyroid carcinoma surgery

目的探讨程序化胸乳入路腔镜甲状腺乳头状癌颈侧区淋巴结清扫术(LND)的可行性。方法病例系列研究。回顾性分析2022年1至11月在深圳市人民医院接受程序化胸乳入路腔镜LND治疗的39例甲状腺乳头状癌患者的临床资料。其中男10例,女29例,年龄(35.95±10.17)岁。分析LND时间、总手术时间、术中出血量、术后引流量、术后住院时间及术后并发症等。结果39例患者中,单侧甲状腺癌18例,双侧甲状腺癌21例;单侧LND 35例,双侧LND 4例。甲状腺癌病灶最大径为(1.48±0.69)cm,淋巴结转移灶最大径为(1.63±0.58)cm。单侧LND手术时间为(124.11±19.92)min(102~170 min),总手术时间(226.42±55.68)min(110~390 min)。清扫的淋巴结数目为(32.40±10.44)枚(12~54枚),转移与检出淋巴结个数207/1393枚。术后引流量(174.64±82.33)ml(41~350 ml)。术后无颈部血肿,无皮肤灼伤,无耸肩障碍。颈部皮肤感觉麻木不适7例,半年后逐渐缓解。术后出院时间(4.77±1.94)d(3~15 d)。结论程序化胸乳入路腔镜LND治疗甲状腺乳头状癌安全可行,可提高手术效率,具有临床应用价值。

Objective To explore the feasibility of endoscopic lymph node dissection(LND)with programmed breast approach for the treatment of papillary thyroid cancer.Methods A case series study.The clinical data of 39 patients with papillary thyroid cancer who underwent endoscopic LND treatment with programmed breast approach in Shenzhen People′s Hospital from January to November 2022 were retrospectively analyzed.There were 10 males and 29 females,aged(35.95±10.17)years.LND time,total surgical time,intraoperative bleeding volume,postoperative drainage volume,postoperative hospital stay and postoperative complications were analyzed.Results Among 39 patients,there were 18 cases of unilateral thyroid cancer,21 cases of bilateral thyroid cancer,35 cases of unilateral LND,and 4 cases of bilateral LND.The maximum diameter of thyroid cancer lesions was(1.48±0.69)cm,and the maximum diameter of lymph node metastases was(1.63±0.58)cm.The operative time of unilateral neck dissection was(124.11±19.92)min(102-170 min),and the total operative time was(226.42±55.68)min(110-390 min).The number of lymph nodes cleaned was(32.40±10.44)(12-54),the number of metastasis and detection was 207/1393.The postoperative drainage volume was(174.64±82.33)ml(41-350 ml).There were no neck hematomas,no skin burns or no shrugging disorders in the postoperative period.There were 7 cases of numbness and discomfort in neck skin sensation,which gradually relieved after half a year.Postoperative discharge time(4.77±1.94)d(3-15 d).Conclusion It is safe and feasible to treat papillary thyroid cancer with endoscopic LND with programmed breast approach,which can improve surgical efficiency and clinical application value.