腔镜辅助下改良颈淋巴结清扫术在甲状腺乳头状癌中应用的安全性

The safety of video-assisted modified radical neck dissection in papillary thyroid carcinoma

目的评价腔镜辅助下改良颈淋巴结清扫术在甲状腺乳头状癌中应用的安全性。方法我们回顾分析了2006年6月1日至2013年6月1日于吉林大学第一医院甲状腺外科行腔镜辅助下改良颈淋巴结清扫术41例的甲状腺乳头状癌患者资料。统计分析其手术并发症以评价此种术式的安全性。结果纳入研究的41例患者按术式被分为以下4组:Ⅰ:单独行侧颈淋巴结清扫。Ⅱ:甲状腺全切加侧颈淋巴结清扫。Ⅲ:甲状腺全切加中央区淋巴结及侧颈淋巴结清扫。Ⅳ:侧颈淋巴结清扫加中央区淋巴结清扫术。术后并发症发生率平均为58.5%。患者术后并发症发生率在第Ⅲ组中高达68%,Ⅱ组其次,可达66.7%,单独清扫侧颈淋巴结组的并发症发生率最低,仅有20%。其中暂时性甲状旁腺功能低下的发生率最高(41.5%)。无1例出现永久性并发症。无手术死亡。结论腔镜辅助下改良颈淋巴结清扫术安全性较高,较少发生永久性并发症,这种手术方式不仅保留颈部功能,保留切口美观,而且并不降低手术的安全性。然而,如果联合中央区淋巴结清扫,特别是甲状腺全切的患者,并发症的发生率将会增加。其中甲状旁腺的损伤最为常见,所以术中保护甲状旁腺显得尤为重要。

Objective Evaluate the safety of video-assisted modified radical neck dissection in papillary thyroid carcinoma. Methods We retrospectively analyzed 41 cases of papillary thyroid carcinoma patients with video-assisted modified radical neck dissection from 2006.06.01 to 2013.06.01 at the thyroid surgery department of the First Hospital of Jilin University, In order to evaluate such surgical safety we analyzed statistically its complications. Results 41 patients included in the study were divided into four groups by the surgical procedures as following： I . Only lateral neck dissection. Ⅱ ： Total thyroiclectomy plus lateral neck dissection. Ⅲ： thyroidectomy plus central and lateral neck dissection. Ⅳ ： lateral plus central neck dissection. The average incidence of postoperative complications was 58.5%. The incidence of postoperative complications in group Ⅲ was up to 68%, Ⅱgroup followed by up to 66.7% .The lowest incidence of complications in the group I was only 20%. Among complications, the temporary hypoparathyroidism was most common （41.5%）. No one case happened with permanent complications. No operative morality. Conclusion The video-assisted modified radical neck dissection is safe with less permanent complications from this surgical approach which not only preserves the neck functions, retains notch beauty, but did not reduce the safety of surgery. However, if with central neck dissection, especMly in patients with total thyroidectomy, the incidence of complications will increase. The most common complication is hypoparathyroidism, so intraoperative parathyroid protection is particularly significant.