选择性颈淋巴结清除术在乳头状甲状腺癌手术治疗的临床应用

Selective neck dissection in surgical treatment of papillary thyroid cancer

目的:探讨乳头状甲状腺癌选择性颈淋巴结清除术的手术指征、手术方法和效果。方法:回顾性分析2007年7月—2011年1月的544例早中期(I期364例,II期89例,III期91例)乳头状甲状腺癌患者施行甲状腺切除加选择性颈淋巴结清除术的临床资料。对手术指征、手术方法、并发症和术后颈淋巴结的病理结果进行分析。结果:544例中,150例行中央组(VI组)清除;325例(59.7%)的清除范围≤3组。此544例均采用普通颈部横切口完成手术。总的淋巴结阳性率67.4%(367/544)。其中,VI组阳性率为54.4%(296/544),IV组44.2%(174/394),III组45.9%(181/394),II组34.2%(68/199)和V组9.0%(6/65)。VI组阳性率与IV,III,II组比较差异无统计学意义(P>0.05)。39例标本中找到1枚误切的甲状旁腺(7.2%,39/544);86例有一过性低钙表现(15.8%,86/544),无永久性者;26例有暂时性喉返神经麻痹(4.8%,26/544),无永久性者。544例随访时间超过半年者时颈部超声未见淋巴结肿大。结论:在早中期乳头状甲状腺癌患者实施选择性淋巴结清除术是合理的,它是一种规范的、个体化的手术方式,具有较高的临床实用价值。

Objective：To investigate the indications,surgical techniques and efficacy of selective neck dissection（SND） for papillary thyroid cancer. Methods：The clinical data of 544 patients with early-and mid-stage papillary thyroid cancer（364 cases of stage I,89 cases of stage II and 91 cases of stage III） undergoing thyroidectomy plus SND were retrospectively analyzed. Results：Of the 544 patients,150 cases underwent central（level VI） neck dissection only and 325 cases（59.7%） of SND encompassed no more than three nodal levels.Operations of all the 544 patients were done through transverse neck incision.The overall positive lymph node rate was 67.4%（367/544） and separately,the positive rate of VI,IV,III,II and V level was 54.4%（296/544）,44.2%（174/394）,45.9%（181/394）,34.2%（68/199） and 9.0%（6/65）,respectively.The positive rate of level VI had no significant difference compared with than that of level IV,III or II（all P0.05）.A single parathyroid gland that was resected by mistake was found in 39 cases（7.2%,39/544） of specimens,and 86 cases（15.8%,86/544） had transient hypocalcemia but no permanent hypocalcemia occurred.Twenty-six cases（4.8%,26/544） had transient vocal cord paralysis but no permanent one was noted.No enlarged cervical lymph node was detected by ultrasound in the 544 patients during the follow-up period of more than 6 months after surgery. Conclusion：It is reasonable to perform SND in patients with early-and mid-stage papillary thyroid cancer.Moreover,SND is a standardized and individualized procedure with a high clinical value.