长低位弧形切口保留颈丛神经的择区性颈淋巴结清扫术在分化型甲状腺癌术中的应用价值

Application value of selective cervical lymph node dissection with long low arc incision and cervical plexus preservation for differentiated thyroid carcinoma

【目的】总结长低位弧形切口保留颈丛神经的择区性颈部淋巴结清扫术在分化型甲状腺癌中的应用。【方法】回顾性分析2010年2月至2012年2月我科收治的54例临床考虑部分CN0以及颈侧区转移CN1b甲状腺癌患者,在原发灶根治的同时施行了保留颈丛神经的择区性颈部淋巴结清扫术。比较长低位弧形切口（36例）与传统的L型切口（18例）手术时间和术后淋巴结清扫数。【结果】颈部的淋巴结转移区域为Ⅵ区（76.2%）、Ⅳ区（68.4%）、Ⅲ区（56.2%）、Ⅱa区（15.8%）、Ⅱb区（0%）和Ⅴb区（14.5%）。术后患者的耳部、下颈部和肩部均未出现明显异常。12～28个月随访期,患者未出现局部复发。与传统L型切口相比,长低位弧形切口的手术时间明显缩短,且IIb、III和V区淋巴结清扫数显著降低（P〈0.05）。【结论】对于临床考虑颈侧区转移（CN1b）部分CN1a以及穿刺活检证实颈侧区转移的分化型甲状腺癌,在没有Ⅴa区及Ⅱb转移或没有淋巴结明显外侵的首次手术患者,保留颈丛的择区性颈淋巴结清扫可以作为替代根治性或改良性颈淋巴结清扫的一种选择。与传统L型切口相比,具有一定优势,特别是适用于IIb、III和V区淋巴结转移的患者。

【Objective】To investigate the application value of selective cervical lymph node dissection with long low arc incision and cervical plexus for differentiated thyroid carcinoma（DTC）.【Methods】A total of 54 cases with CN0 or CN1 b DTC undergoing radical operation and selective cervical lymph node dissection with cervical plexus preservation were retrospectively investigated from February2010 to February 2012. Operation time and postoperative lymph node number were compared between patients with long low arc incision（36 cases） and patients with traditional L-curved incision（18cases）.【Results】The rates of cervical lymph node metastases were76.2%（level VI）, 68.4%（level IV）, 56.2%（level III）, 15.8%（level IIa） and 14.5%（Vb）, respectively. There was no obvious impairment in the areas of ears, lower necks and shoulders. No local recurrence occurred during the 12-to-28 month follow-up period. Compared with the traditional L-curved incision, the operation time of long low arc incision was obviously shorter and lymph node number in level IIb, III and V decreased significantly（P〈0.05）.【Conclusion】The selective cervical lymph node dissection with cervical plexus preservation for CN1 b or CN1 a DTC without level Ⅴa/Ⅱb or aggressive metastasis can take the place of radical or modified cervical lymph node dissection. Compared with traditional L-curved incision, long low arc incision has advantages and is appropriate for the patients with level IIb, III or V metastasis.