同期双侧颈淋巴结清扫治疗高分化及髓样甲状腺癌

Simultaneous bilateral lymph node dissection applied in highly differentiated and medulary thyroid carcinoma

目的 探讨同期双侧颈淋巴结清扫治疗高分化及髓样甲状腺癌的适应证、原发灶的根治范围和颈淋巴结清扫术式的选择。方法 回顾我院收治的22例双侧颈淋巴结转移的甲状腺乳头状、滤泡状及髓样癌的病例资料，10例行一侧叶切除加对侧叶近全切除根治原发癌，同时行一侧传统颈清扫加对侧改良清扫（下称传统清扫组）；12例行全甲状腺切除根治并行同期双侧颈淋巴结改良清扫（下称改良清扫组）。结果 单侧癌9例，双侧癌13例，20例原发癌为多中心性。双侧改良清扫组颜面水肿率显著低于传统清扫组（16．7％vs100％，P〈0．01），渗出量[（300．4±40．65）ml vs（406．8±39．85）ml]、术后住院时间[（8．3±1．16）d vs（12．5±1．58）d]也低于传统清扫组（P〈0．01）。结论 发生双侧颈淋巴结转移的高分化甲状腺癌及髓样癌，应行全甲状腺切除及双侧颈淋巴结清扫，同期双侧的改良颈淋巴结清扫不但术后恢复快、生活质量高，而且远期疗效肯定，值得推广和应用。

Objective To explore the indications, management of primary lesions and surgical approach of simultaneous bilateral neck dissection for highly differentiated and medulary thyroid carcinoma with bilateral neck lymphoid metastases. Methods The clinical data of 22 patients of highly differentiated and medulary thyroid carcinomas with bilateral neck lymphoid metastases were retrospectively reviewed. Lobectomy and contralateral near total lobectomy were performed in 10 patients, who accepted unilateral classical radical neck dissection plus contralateral modified radical neck dissection simultaneously. The other 12 cases underwent total thyroidectomy and bilateral modified radical neck dissection simultaneously. Results Nine cases had primary thyroid cancer in one lpbe, 13 in two lobus and 20 cases had multiple primary lesions. The group accepted bilateral modified radical neck dissection has lower facial edema rate（ 16.7% vs 100%, P〈0.01）, less wound drainage （300.4 ±40.65 ml vs 406.8 ±39.85 ml, P 〈0.01 ） and shorter hospital stay than classic neck dissection group （8.3 ±1.16 d vs 12.5 ±1.58 d, P 〈 0.01 ）. Conclusions Total thyroidectomy and bilateral lymph dissection should be applied to patients of highly differentiated and medulary thyroid carcinoma with bilateral neck lymphoid metastases, and simultaneous bilateral modified radical neck dissection is beneficial to those patients. Thus, the method is worth being used.