改良保留颈丛的低颈领式切口功能性颈淋巴结清扫术(附95例报告)

Modified neck lymphadectomy with preservation of cervical plexus through a low-collar incision: 95 cases report

目的:探讨一种改良保留颈丛的领式切口功能性颈淋巴结清扫术治疗甲状腺乳头状癌。方法:2012年1月至2013年12月95例甲状腺乳头状癌病人在解放军第八五医院普外科行改良保留颈丛的功能性颈淋巴结清扫术。结果:95例完整清扫Ⅱ、Ⅲ、Ⅳ、Ⅴ区淋巴结。保留锁骨上神经的中间及向内的分支等重要颈部结构。Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴa和Ⅴb区淋巴结转移率分别为34.7%、12.6%、55.8%、82.1%、4.2%和14.7%。病人术后外耳、肩部、、锁骨下和颈外侧感觉均存在。结论:该改良术式既能完整清扫与甲状腺乳头状癌有关的颈侧区淋巴结,又保留颈丛神经的大多数感觉功能,可作为替代择区性颈淋巴结清扫术的一种选择。

Objective To discuss a modified neck lymphadectomy with preservation of cervical plexus through a low- collar incision in the patients with papillary thyroid carcinoma. Methods The modified neck lymph node dissection with preservation of cervical plexus through a low-collar incision was performed for 95 patients with papillary thyroid carcinoma in our department from January 2012 to December 2013. Results The lymphadenectomy in level Ⅱ, Ⅲ, Ⅳ and Ⅴ was given for all patients with the internal and medial branches of supraclavicular nerve preserved. The lymph node metastasis rate was 34.7%, 12.6%, 55.8%, 82.1%, 4.2% and 14.7% in level Ⅱ a, Ⅱ b, Ⅲ, Ⅳ, Ⅴa and Ⅴb respectively. The decrease in the sensation of ears, lower and later neck, shoulders was not found. Conclusions The modified lymphadenectomy of later neck combined with preservation of cervical plexus during the resection of papillary thyroid carcinoma, which could keep the sensation of the most part in neck, may be an alternative method of the selective neck dissection for lymph nodes.