保留颈丛的改良性颈清扫术在甲状腺乳头状癌中应用

Modified radical neck dissection with the preservation of cervical plexus for papillary thyroid cancer patients

目的:探讨保留颈部肌肉、神经和主要血管的全功能性颈清扫术在甲状腺乳头状癌中的应用。方法:19例年轻甲状腺乳头状癌患者,施行保留肌肉和颈丛神经的全功能性颈清扫术。结果:19例患者术后全部耳部感觉良好,下颈部及肩部无麻木感。颈部肌电图术前、术后无差异。颈部外观无改变。结论:手术适应证:(1)N0的甲状腺乳头状腺癌。(2)N1的甲状腺乳头状腺癌,淋巴结转移仅仅局限Ⅵ区者,或颈内静脉旁淋巴结较小(长径<3 cm)无包膜外侵犯者。手术禁忌证:手术前已有不规范颈清扫术史者;颈淋巴结广泛转移或淋巴结有明显外侵者。

Objective： To utilize the modified radical neck dissection for the papillary thyroid cancer patients with the preservation of the muscle, cluster nerve, and main vasculature. Methods. Nineteen young patients with papillary thyroid cancer underwent functional neck dissection with the preservation of the muscle and cluster nerve in our hospital. Results： All the nineteen patients had no numbness in the ear, the lower part of neck and the shoulder after the surgery. There was no difference in electromyography before and after surgery. The appearance of the neck did not change. Conclusion. The indications of the modified radical neck dissection included （ 1 ） NO stage papillary thyroid cancer; （2） N1 stage papillary thyroid cancer. The lymph nodes were limited in VI area or the diameter of the lymph nodes near the internal jugular vein was less than 3 cm without capsule invasion. The contraindications included irregular radical neck dissection history, wide cervical lymph node metastasis or the apparent invasion.