采用改良L型切口行甲状腺癌颈清扫术

A modified L shape incision in neck dissection for thyroid cancer

目的探索更加美观隐蔽的甲状腺癌颈清扫术手术切口。方法将2009年1月~2012年12月在我院接受颈清扫术的72例甲状腺癌颈淋巴结转移患者采用改良L型切口进行手术。其中22例患者行甲状腺全切术+患侧I~Ⅵ区颈清扫术;另50例患者单纯行颈清扫术,清扫范围主要为I^V区淋巴结。颈清扫切口行于斜方肌表面发际前缘自乳突尖后向下行至锁骨上约1.5cm处循皮纹横行向前至颈前中部或与原甲状腺手术切口相连。其中根治性颈清扫术4例,功能性颈清扫术68例。结果72例患者共行83侧颈清扫术,均行改良L型切口。手术过程均顺利,术野暴露满意,手术时间为128~196min,平均145.3±23.8min。共11例患者出现术后并发症,其中颈部积液6例、副神经损伤3例、乳糜漏2例。无皮瓣坏死、切口感染等并发症发生。术后患者颈部切口瘢痕隐蔽,外观影响小。术后随访6个月~4年,淋巴结复发率为0.0%。结论采用改良L型切口行颈清扫术暴露满意,手术并发症少,术后切口隐蔽,是甲状腺癌颈清扫术一种较为理想的手术入路。

Objective To explore a cosmetic and secluded incision in the neck dissection for thyroid cancer. Methods The modified L shape incision was used for neck dissection in 72 patients with cervical lymph nodes metastases of thyroid carcinoma from January 2009 to December 2012 in our hospital. Among the 72 patients , 22 underwent simultaneous the total thyroidectomy and the affected side neck dissection;whereas the other 50 patients, who suffered from cervical lymph node metastases after thyroidectomy, were treated with affected side neck dissection alone. The longitudinal portion of the incision runs from the mastoid process downward, along the surface of the trapezius muscle and hairline border, then curves gently at approximately 1.5 cm above the clavicle. The transverse component follows the natural cervical crease and extended to the middle of the neck or the thyroidectomy scar. The neck dissection mainly involves level Ⅰ to Ⅴ lymph node groups. Eighty-three procedures of neck dissection were performed in 72 patients, including 4 radical neck dissection and 68 functional neck dissection. Results We employed modified L shape incision in the 72 patients who underwent neck dissection. It was successful during the surgery;meanwhile,the incision permits ideal exposure of the operative field.The operation time was 128-196 min,and the mean time was 145.3＆#177;23.8 min.Eleven patients developed complications related to neck dissection, including 6 cases of neck effusion, 3 spinal accessory nerve injury and 2 chylous leakage. No skin flap necrosis, incision infection or any other complications occured. All patients had a satisfactory postoperative appearance, secluded and cosmetic incisions. The follow-up period in these patients were 6 months to 4 years, no cervical recurrence was identified in any case. Conclusion With ideal exposure of surgical field, low operation complications and a cosmetic and secluded incision scar, the modified L shape incision is an ideal approach to the neck dissection for thyroid cancer.