低位弧形切口用于甲状腺癌功能性颈部淋巴结清扫术价值研究

Clinical value of low-transverse arc collar incision with cervical plexus preservation for papillary thyroid carcinoma

目的探讨低位弧形切口保留颈丛神经的颈部淋巴结清扫术的彻底性、安全性和感官满意度。方法回顾性分析2013年1-12月复旦大学附属肿瘤医院头颈外科收治的284例甲状腺乳头状癌（PTC）伴侧颈淋巴结转移病人的临床资料。均行患侧甲状腺腺叶和峡部切除术＋中央区（Ⅵ区）及同侧或双侧颈部选择性淋巴结清扫术（Ⅱ-Ⅴ区）。分别比较低位弧形切口（低位组,279例）和传统＂L＂形切口（传统组,36例）病人颈部各区淋巴结转移发生率和淋巴结清扫数,并通过量表评价两组病人术后生活质量及术后并发症。结果低位组病人手术时间短于传统组病人,差异有统计学意义（P〈0.05）;低位组与传统组病人侧颈区的总淋巴结清扫数差异无统计学意义（P〉0.05）,但低位组病人Ⅱb、Ⅴ区淋巴结清扫数低于传统组病人（P〈0.05）。低位弧形切口在瘢痕色泽、血管分布、厚度、柔软度以及病人肩部僵硬、紧缩感、疼痛和麻木感等方面得分均降低,组间差异均有统计学意义（P〈0.05）。相关性分析显示,淋巴结转移累及Ⅱa区时,Ⅱb区转移风险增高（r=0.197,P〈0.001）;多区转移时,Ⅱa和Ⅴ区转移风险均增高（r=0.242、0.243,P〈0.001）。结论低位弧形切口保留颈丛神经的颈淋巴结清扫术能在保证治疗彻底性和安全性的同时改善病人的术后生活质量,但对于Ⅱa区或多区转移的病人,仍推荐采用传统＂L＂形切口。

Objective To evaluate the thoroughness, safety and satisfaction with the appearance of low-transverse arc collar incision （low-collar incision for short） with cervical plexus preservation for papillary thyroid carcinoma （PTC）. Methods The clinical data of 284 patients diagnosed with PTC in Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center from Jan. 2013 to Dec. 2013 were analyzed retrospectively. All the patients were performed the operation of total thyroidectomy and central lymph node （level VI） and/or ipsilateral or bilateral neck （level II - V） dissection. The metastatic rates and resected cervical lymph node numbers of patients with low-collar incision （group low-incision, 279 patients） and conventional incision （group conventional-incision, 36 patients） were calculated respectively and the patients＇ postoperative life quality was estimated through scales and compared with complications. Results The operation time in group low-incision was shorter than that in group conventional-incision, which is with significant difference （P〈0.05）. There was no difference in total resected lymph node numbers between two types of incisions （P 〉 0.05）. But resected lymph node numbers of level II b and V in group low-incision were lower than those in group conventional-incision. Postoperative life quality was improved in group low-incision （P〈0.05）. Correlation analysis showed the risk of level II b metastasis increased when level 1I a involved （r=0.197 and 0.067, P〈0.001）, and the risk of level II a and V metastasis increased when multi-levels involved （r=0.242 and 0.243 ,P〈0.001）. Conclusion Low-transverse arc collar incision with cervical plexus preservation for papillary thyroid carcinoma has the characteristics of thoroughness, safety and satisfaction with the appearance. However, conventional incision should be recommended for patients with II a or muhi-levels metastasis.