甲状腺癌同期双侧颈清术68例临床分析

Clinical analysis of one-stage bilateral neck dissection for patients with thyroid carcinoma:a report of 68 cases

目的探讨甲状腺癌同期双侧颈淋巴结清扫术的适应证及注意事项。方法回顾性分析1990年1月—2005年12月间行同期双侧颈部淋巴结清扫术的68例甲状腺癌患者临床病理资料。结果全组68例中双侧淋巴结均阳性60例(88.2%),单侧淋巴结阳性4例(5.9%),双侧淋巴结均为炎症4例(5.9%)。单侧甲状腺癌对侧颈部淋巴结肿大、双侧甲状腺癌单侧颈部淋巴结肿大及峡部癌的双颈淋巴结转移率分别为100.00%(7/7);90.00%(9/10),66.67%(4/6)。术后并发症为:颜面部及皮瓣水肿7例,头痛2例,术后声嘶5例,甲状旁腺功能低下7例,永久性甲状旁腺功能减退1例,左侧淋巴液漏1例,一侧副神经受损3例。无手术相关死亡。结论单侧甲状腺癌对侧颈部淋巴结肿大、双侧甲状腺癌单侧颈部淋巴结肿大及峡部甲状腺癌这三种情况应属于高风险双颈转移,应行同期双侧颈清术,以提高患者的生存率和生存质量。该术式安全且无严重手术并发症。

Objective To explore the indications and attention points in one-stage thyroidectomy and bilateral neck dissection for thyroid carcinoma.Methods The clinical and pathological data of 68 thyroid carcinoma patients treated with one-stage thyroidectomy and bilateral neck dissection from Jan 1990 to Dec 2005 were reviewed retrospectively.Results There was no operative death in this series.Of the 68 patients,60 had bilateral and 4 had unilateral positive lymph nodes;4 had negative lymph nodes.The metastatic rate of patients who had unilateral thyroid cancer with contralateral cervical enlarged lymph nodes,bilateral thyroid cancer with unilateral cervical lymph nodes and isthmus cancer with lymph nodes was 100%（7/7）,90%（9/10） and 66.67%（4/6） respectively.Postoperative complications include 7 cases of facial and flap edema,2 headache,5 postoperative hoarseness,7 temporary hypoparathyroidism,1 permanent hypoparathyroidism,1 left chylus fistula,and 3 unilateral accessory nerve injury.Conclusions The patients with unilateral thyroid cancer and enlarged contralateral neck lymph nodes,with bilateral thyroid cancer and unilateral cervical lymph nodes,and with isthmus cancer and enlarged lymph nodes are high-risk patient of bilateral neck metastasis,and should be treated with one stage thyroidectomy and bilateral cervical lymph node dissection.The procedure is safe,no serious postoperative complications occurred,and the survival rate and life quality can be improved.