腔镜辅助下行甲状腺分化癌颈侧区淋巴结清扫术(附5例报告)

Endoscopic-assisted cervical lymph node dissection for treatment of differentiated thyroid cancer: with a report of 5 cases

目的：研究腔镜辅助下分化型甲状腺癌颈侧区淋巴结清扫术的可行性。方法：为5例分化型甲状腺癌患者行腔镜辅助下颈侧区淋巴结清扫术,总结分析其手术时间、术后病理结果、并发症及患者满意度等指标。结果：5例均顺利完成手术,手术时间160～230 min。切口均一期甲级愈合,术后住院6～8 d。无喉返神经及甲状旁腺损伤、术后出血、淋巴漏等并发症发生,患者对切口非常满意。术后病理均提示为乳头状癌。手术2～3个月后行I131治疗,均未发现颈侧区有转移淋巴结残留,随访至今,未见复发、转移。结论：在腔镜辅助下行颈淋巴结清扫术是安全、可行的,具有患者创伤小、安全性高、美容效果佳等优点,可用于分化型甲状腺癌的手术治疗。

Objective ：To investigate the feasibility of endoscopic assisted cervical lymph node dissection for treatment of differentiated thyroid cancer. Methods：Five patients with differentiated thyroid carcinoma underwent endoscopic-assisted cervical lymph node dissection. The outcomes of the study included duration of the operation, pathological outcomes, complications, and satisfaction of patients to the operation. Results ：All patients had a successful operation. The duration of the new operation was 160-230 min. All incisions healed by first intention. Postoperative hospital stay was 6-8 d. No complications such as injury of parathyroid gland or recurrent laryngeal nerve, postoperative hemorrhage, lymphorrhagia occurred. Patients were satisfied with the new operation. Pathological results showed papillary carcinoma, a number of lymph nodes in dissection tissues and metastases were found. Patients underwent treatment of I131 2-3 months later,no residual metastatic lymph nodes were found at neck. Till now,no recurrence or metastasis occurred. Conclusions ： The method of the endoscopic-assisted cervical lymph node dissection is safe and practical in the treatment of differentiated thyroid carcinoma. The new operation is more reasonable in appearance, minimal invasion, safety and effectiveness compared with a totally endoscopic type and traditional open operation.