腔镜上纵隔淋巴结清扫术在甲状腺乳头状癌治疗中的运用

Application of endoscopic upper mediastinal lymph node dissection in treatment of papillary thyroid carcinoma

目的:探讨经颈部腔镜辅助或经颈部腔镜辅助联合胸腔镜行上纵隔淋巴结清扫术(UMLND)治疗甲状腺乳头状癌的可行性。方法:回顾性分析2015年12月—2018年7月在浙江大学医学院附属邵逸夫医院头颈外科接受腔镜UMLND治疗的11例甲状腺乳头状癌患者的临床资料。男5例,女6例;年龄21～73岁,平均(45±18)岁。甲状腺腺叶切除术、中央区清扫术及侧颈清扫术在直视或腔镜辅助下完成,UMLND在经颈部腔镜辅助或腔镜辅助联合胸腔镜下完成。结果:11例患者中10例在腔镜下顺利完成手术,1例因转移淋巴结粘连无名静脉在腔镜下无法安全分离而中转开胸手术。腔镜辅助UMLND平均手术时间为(58.7±12.1)min,术后平均住院时间(9.5±9.6)d。UMLND平均获取淋巴结数目为(8.4±3.3)枚,平均转移淋巴结数目为(3.5±2.6)枚。无UMLND相关并发症发生。术后平均随访时间(16±7)个月,患者血清甲状腺球蛋白平均浓度(1.85±2.21)ng/mL,所有病例未见肿瘤残留或复发。结论:经颈部腔镜辅助或腔镜辅助联合胸腔镜行UMLND治疗甲状腺乳头状癌安全可靠,手术清扫彻底,微创美容效果明显,有较大的临床应用价值。

Objective: To evaluate the feasibility of endoscopic-assisted or endoscopic-assisted combined with thoracoscopic upper mediastinal lymph node dissection (UMLND) via transcervical approach for papillary thyroid carcinoma (PTC).Methods: The clinical data of 11 PTC patients undergoing endoscopic UMLND in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from December 2015 to July 2018 were retrospectively analyzed. Of the patients, 5 cases were males and 6 cases were females with a mean age of (45±18) years. Total thyroidectomy, central neck dissection, and lateral neck dissection were performed by open or endoscopic-assisted approach. UMLND was performed by either transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic approach.Results: Of the 11 patients, operation was successfully completed under endoscopic assistance in 10 cases, and 1 patient was converted to open thoracotomy because of severe adhesion of the metastatic lymph nodes to the innominate vein and it was difficult to ensure a safe separation. The average operative time of endoscope-assisted UMLND was (58.7±12.1) min, and the average length of postoperative hospital stay was (9.5±9.6) d. The average number of lymph nodes obtained from UMLND was 8.4±3.3, with a mean number of metastatic lymph nodes of 3.5±2.6. There were no complications associated with UMLND. The mean follow-up time was (16±7.0) months, the average serum thyroglobulin concentration of the patients was (1.85±2.21) ng/mL, and no tumor residual or recurrence was noted in any of the patients.Conclusion: Transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic UMLND is a safe and reliable approach for the treatment of thyroid papillary carcinoma, with a thorough clearance and minimally invasive operation as well as cosmetic results. So, it has greater clinical application value.