甲状腺癌上纵隔淋巴结转移外科治疗策略

Surgical treatment for mediastinal metastasis of thyroid carcinoma

甲状腺癌上纵隔淋巴结转移临床上并不罕见,但往往临床医生的重视不足,其在本质上仍属于区域淋巴结转移,上纵隔淋巴结清扫是其主要的治疗手段。上纵隔淋巴结清扫总体仍遵循整块切除的原则,清除相应区域的淋巴脂肪组织。根据手术范围不同主要分为颈部入路和胸骨劈开入路,颈部入路的上纵隔淋巴结清扫往往可处理主动脉弓以上的活动淋巴结,可为中央区淋巴结清扫的一部分,而胸骨劈开入路暴露更为充分,主要针对主动脉弓上缘以下或与血管关系密切的淋巴结。甲状腺外科医生应熟悉相关解剖和手术操作原则,可较为安全地完成上纵隔淋巴结清扫手术,获得根治性切除的病人仍有良好的预后。

Mediastinal metastasis is not rare in patients with thyroid carcinoma but lacking enough attention.Mediastinal nodes involvement in thyroid cancer patients belongs to regional metastasis and surgery is the main treatment. Mediastinal dissection should remove certain soft tissue and comply with ＂en bloc＂ principle. Trans-cervical and sternotomy are two main approaches of mediastinal dissection. Lymph nodes above the aorta usually can be removed with trans-cervical approach and sternotomy may be performed when nodes are under the upper border of the aorta or adhere with main vessels. Thyroid surgeons should be familiar with anatomy and surgical techniques of mediastinal dissection. The prognosis can be satisfactory after radical mediastinal dissection.