低位领式切口保留颈丛择区性颈侧方淋巴结清扫术在甲状腺乳头状癌中的应用

Preservation of the cervical plexus with a selective neck dissection through a low-collar incision in patients with papillary thyroid carcinoma

目的 总结低位领式切口保留颈丛的择区性颈侧方淋巴结清扫术（颈清术）在甲状腺乳头状癌中的应用和经验.方法 2011年1月至2013年8月对66例乳头状癌患者行全甲状腺切除和低位领式切口保留颈丛的择区性颈清术.结果 Ⅵ区淋巴结转移率为69.7％,颈侧方淋巴结（Ⅱ、Ⅲ、Ⅳ、Ⅴb）转移率为72.7％,主要集中在Ⅲ和Ⅳ.患者术后无明显下颈部、耳部和肩部感觉异常,随访1 ～ 30个月无局部复发.结论 临床怀疑或穿刺证实颈侧方淋巴结转移的乳头状癌患者,在没有广泛淋巴结转移（Ⅴa转移）或淋巴结明显外侵的情形下,低位领式切口保留颈丛的择区性颈清术良好的兼顾了肿瘤根治和功能外观,是一种安全而合理的术式.

Objective To generalize the utility and experience of preserving the cervical plexus in selective neck dissections for papillary thyroid carcinoma（PTC）.Methods Preservation of the cervical plexus was used for selective neck dissection through a low-collar incision in 66 cases of PTC from January 2011 to August 2013 in our hospital.Results The cervical lymph node metastasis rate in level Ⅵ was 69.7％,the lateral lymph node metastasis rate（level Ⅱ,Ⅲ,Ⅳ and Ⅴ b）was 72.7％,and the most common site of lymph node metastases was level Ⅲ and Ⅳ.No sensation impairment in the lower necks,ears and upper shoulders was found.There was no local recurrence at the time of follow-up for 1 to 30 months.Conclusion In papillary thyroid carcinoma patients with clinically suspicious or biopsy-confirmed lateral cervical lymph node metastasis,preservation of the cervical plexus with a selective node dissection through a low-collar incision is a safe and reasonable choice if the patients have no extensive cervical lymph node metastases（level Ⅴa）and extranodal invasion.