甲状腺中静脉在甲状腺乳头状癌(cN_0)Ⅵ区颈淋巴结清扫术中定位喉返神经的意义

The significance of middle thyroid vein in the Ⅵ region neck dissection

目的:探讨甲状腺中静脉在甲状腺乳头状癌(cN0)Ⅵ区颈淋巴结清扫术中定位喉返神经的意义及手术注意事项。方法:回顾性分析甲状腺乳头状癌(cN0)213例,术中以甲状腺中静脉为标志来定位喉返神经后行Ⅵ区颈淋巴结清扫术。结果:213例患者中颈淋巴结转移82例,淋巴结转移率38.4%。喉返神经永久性损伤2例,暂时性损伤2例,永久性甲状旁腺功能减退2例,暂时性甲状旁腺功能减退6例。3例在术后3年内出现颈侧区淋巴结转移,转移率为1.36%。结论:以甲状腺中静脉为标志定位喉返神经后行Ⅵ区颈淋巴结清扫术,喉返神经损伤率和甲状旁腺损伤率较低。因而认为,以甲状腺中静脉为标志暴露喉返神经全程后,行Ⅵ区颈淋巴结清扫术是安全有效的。

Objective：To investigate the effect of Ⅵ region neck dissection in thyroid papillary carcinoma surgery and to prompt the key matters in such surgery.Method：Retrospectively analyzed 213 cases of thyroid papillary carcinoma treated by Renji ENT Department from 2003 to 2009.Under each case,we implemented the Ⅵ region neck dissection after marking recurrent laryngeal nerve with middle thyroid vein.Result：Among the 213 cases of thyroid papillary carcinoma performed with Ⅵ region neck dissection,82 cases were positive,3 cases incurred recurrent laryngeal nerve injury with 2 cases of permanent RLN injury and 2 case of temporary injury,2 cases showed permanent Hypoparathyroidism,and 6 cases showed temporary Hypoparathyroidism.In 3 cases the metastasis of neck lymph arose within 3 years.Conclusion：Marking recurrent laryngeal nerve with middle thyroid vein not only helps to lower the possibility of injuring RLN and parathyroid glands in thyroidectomy,but also makes the Ⅵ region neck dissection an feasible treatment for thyroid papillary carcinoma.