分化型甲状腺癌保留颈丛神经功能性颈淋巴结清扫术的临床应用

Preservation of cervical plexus in the functional neck dissection of differentiated thyroid cancer

目的:探讨分化型甲状腺癌功能性颈清扫术中保留颈丛感觉支的临床应用。方法:随机选取我院2008年1月～2008年7月住院治疗22例临床病理证实的分化型甲状腺癌患者,术前均经B超、CT证实有颈淋巴结肿大,淋巴结包膜完整无融合,根据NCCN分期为N0～N1a的患者,施行保留颈丛感觉支的功能性颈清扫术,观察术后神经功能情况。结果:保留胸锁乳突肌、颈内静脉、副神经及耳大神经22例,枕小神经17例,锁骨上神经18例,颈横动静脉14例。所保留的神经功能随访6个月内均能恢复,上肢活动良好,无颈部肿瘤复发。22例患者术后耳部感觉良好,下颈部及肩部无麻木感。结论:分化性甲状腺癌保留颈清术既能达治疗目的又能提高患者术后的生活质量,值得临床推广应用。

Objective： To discuss the functional neck dissection preserving cervical plexus in the treatment of differentiatedlhyroid cancer. Methods： Twenty two cases of papillary thyroid cancer underwent functional neck dissection while preserving the cervical plexus. All of them had lymph node tumescence and the envelop of lymph were integrity, which were confirmed by CT and B ultrasonography. According to NCCN, the stage of lymph nodes were at N0-N14. Underwent functional neck dissection while preserving the cervical plexus,observing the function recovery of the cervical plexus. Results： All 22 cases were preserving the sternocleidomastoid,internal jugular vein,accessory nerve and the great auricular nerve. Among them, 17 cases preserving the lesser occipital nerve, 18 cases preserving the supraclavicular nerves, 14 cases preserving the transverse artery and vein of neck. After following up 6 months, all the preserved nerve can recovery its function, the uper limb moved easily and without recrudesence of tumor. All 22 cases are sensed well at ear area,and without anaesthesia on shoulder and lower cervix. Conclusions： The preserving cervical plexus functional neck dissection are worth to extend and application in therapy of differentiated thyroid cancer. It can reach to the aim of radical therapy as well as raise the living standard of patient.