保留颈丛的功能性颈淋巴结清扫术在分化型甲状腺癌中的应用

Application of functional neck dissection with preservation of cervical plexus in differentiated thyroid carcinoma

目的探讨低位领式切口保留颈丛神经的颈淋巴结清扫术在治疗分化型甲状腺癌的应用。方法39例分化型甲状腺癌颈侧区淋巴结转移（cNlb）患者在我院施行低位领式切口保留颈丛神经的择区性颈部淋巴结清扫术，并分析其淋巴结转移分布、并发症、复发率及临床疗效。结果39例患者颈侧区淋巴结转移主要分布Ⅳ区（76．9％）、Ⅲ区（64．1％）、Ⅱa区（38．4％）、Ⅱb区（2．6％）和ⅤB区（12．8％）。其中并发一过性的上颈部肿胀1例、出血1例、乳糜漏1例。术后双侧耳部、下颈、肩部和锁骨下皮肤感觉均无明显减退。随访5～60个月未见局部复发。切口较“L”型更加美观。结论低位领式切口保留颈丛神经的颈淋巴结清扫术具有不增加复发率、切口小、保留颈丛神经的优点。

Objective Investigate application of functional neck dissection with preservation of cervical plexus in differentiated thyroid cancer. Methods In the current hospital, 39 cases of patients with differentiated thyroid cancer and lymph nodes metastases were treated with selective neck dissection through a low-collar incision while preserving cervical plexus. The distribution of the lymph nodes, complications, recurrence rate, and clinical effect are studied. Results In the 39 cases, the cervical lymph node metastases were mainly distributed at Level Ⅳ（76.9%） , Level Ⅲ（64.1%） , Level Ⅱa （38.4%） , Ⅱb（2.6% ） and Ⅴb （12.8%）. Three cases of complications were found after surgeries： one case of neck swelling, one case of bleeding, and one case of chyle leakage. No impairment in the sensation of ears, lower neck, shoulders, and the subclavian skin was found. No local relapse was found during the 5 - 60 months＇ follow-ups. Compared with L-shape incision, the Low-collar incision is cosmetically desirable. Conclusion Neck dissection through a low-collar incision with preservation of cervical plexus results in a small incision and preserves cervical plexus while not increasing the recurrence rate.