腔镜甲状腺癌中央区淋巴结清扫技巧与体会(附43例报告)

Skills and experience of endoscopic central region lymph node excision in thyroid carcinoma surgery:with a report of 43 cases

目的:探讨完全腔镜甲状腺癌中央区淋巴结清扫的可行性、有效性及安全性。方法:回顾分析2012年4月至2017年4月采用腔镜手术治疗的43例甲状腺乳头状癌患者的临床资料。结果:43例手术均获成功,手术时间平均(123.37±21.68)min;术中均行中央区淋巴结清扫,其中6例怀疑颈侧区淋巴结转移,加行患侧颈侧区清扫。中央区淋巴结清扫数量平均(5.05±2.14)枚。4例(9.30%)术后出现暂时性声音嘶哑,3例(6.98%)术后发生一过性低血钙症状。术后平均住院(4.21±1.12)d。平均随访(24.91±14.92)个月,局部无复发,颈部外观良好,患者对手术效果均满意。结论:内镜甲状腺手术行甲状腺癌中央区淋巴结清扫是安全、可行的,结合术后综合治疗,预后较好,值得推广。

Objective： To evaluate the feasibility,effectiveness and safety of the totally endoscopic central neck lymph node excision for thyroid carcinoma. Methods： Forty-three patients with papillary thyroid carcinoma underwent endoscopic thyroidectomy and central neck lymph node excision from Apr.2012 to Apr.2017,their clinical data were retrospectively analyzed.Results： All patients underwent surgery successfully,central compartment lymph node excision was performed in all of the 43 patients and ipsilateral neck excision was also performed in 6 patients who were suspected metastatic lateral neck lymph nodes.The mean operative time was（ 123.37±21.68） min.The mean number of lymph nodes harvested in the central compartment was（ 5.05±2.14）.Four patients（ 9.30%） suffered from transient hoarseness. Postoperative transient hypocalcemia occurred in 3 cases（ 6. 98%）. The average postoperative hospital stay was（ 4.21±1.12） d.The average follow-up time was（ 24.91±14.92） months,no evidence of residual or recurrent disease was found.All patients were satisfied with the result of the operation.Conclusions： Endoscopic central region lymph node excision for thyroid carcinoma combined with postoperative comprehensive treatment is safe and feasible with comparatively good prognosis,and it is worthy to be popularized.