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超择区性淋巴结清扫在甲状腺乳头状癌区域性侧颈淋巴结转移中的初步研究 被引量:6

Preliminary study of superselective lymph node dissection in regional lateral cervical lymph node metastasis of papillary thyroid carcinoma
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摘要 目的探讨超择区(Ⅲ、Ⅳ区)性颈淋巴结清扫在临床侧颈区域性淋巴结转移的甲状腺乳头状癌治疗中的应用价值。方法回顾性分析2013年9月至2018年5月,于中国医学科学院肿瘤医院初治的232例颈部Ⅱ区淋巴结阴性cN1b期甲状腺乳头状癌患者的临床病理资料。232例患者中,超择区(Ⅲ、Ⅳ区)性颈淋巴结清扫(超择区组)90例,择区(Ⅱ~Ⅳ区)性颈淋巴结清扫(择区组)142例,对两组患者的淋巴结转移情况进行分析。结果232例患者中,中央区淋巴结转移173例,Ⅱ区淋巴结转移47例,Ⅲ区淋巴结转移147例,Ⅳ区淋巴结转移130例。超择区组和择区组患者出现术后淋巴漏分别为8例和6例(P=0.146)。超择区组中出现肩关节活动障碍0例,择区组为9例,均为术后永久性肩关节活动受限,差异有统计学意义(P=0.015)。超择区组患者出现术后切口长期麻木、发紧等不适2例,术后瘢痕明显5例;择区组术后出现切口长期麻木、发紧等不适27例,术后瘢痕明显26例,差异均有统计学意义(均P<0.005)。全组患者中均无侧颈区域淋巴结复发患者。结论超择区性颈淋巴结清扫在临床侧颈区域性淋巴结转移甲状腺乳头状癌患者的治疗中是可行的、安全有效的,有利于改善患者的生活质量,避免过度医疗。 Objective To explore the applied value of super-selective cervical lymph node dissection in papillary thyroid carcinoma(PTC)patients with clinically suspicious lateral lymph node metastasis(LNM).Methods We retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the Department of Head and Neck Surgical Oncology,National Cancer Center.Among them,90 cases received super-selective neck dissection(levelⅢand IV)and 142 cases underwent selective neck dissection(levelⅡ-Ⅳ).The LNM of two groups were analyzed.Results Postoperative pathological results showed that 173 cases had LNM in the central compartment.The LNM cases of levelⅡ-Ⅳwere 47,147 and 130,respectively.Eight patients of super-selective neck dissection and 6 of selective neck dissection had postoperative lymphatic fistulas(P=0.146).No patients in super-selective neck dissection group while 9 patients in the selective lymph node dissection group had postoperatively permanent impairment of shoulder mobility,the difference was statistically significant(P=0.015).In the super-selective neck dissection group,2 patients had long-term postoperative incision discomfort,and 5 cases had obvious cicatrix after surgery.In the patients with selective neck dissection,27 cases experienced long-term incision discomfort after surgery,and 26 patients had apparent scar tissue,the differences were statistically significant(P<0.005).There was no recurrence during the follow-up.Conclusions Super-selective neck dissection is a feasible,safe and effective treatment for cN1b PTC patients.It can improve the quality of postoperative life and avoid the over treatment for patients.
作者 赵博慧 黄泽浩 黄樱城 张溪微 安常明 牛丽娟 李正江 Zhao Bohui;Huang Zehao;Huang Yingcheng;Zhang Xiwei;An Changming;Niu Lijuan;Li Zhengjiang(Department of Head and Neck Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100021,China)
出处 《中华肿瘤杂志》 CAS CSCD 北大核心 2021年第4期484-489,共6页 Chinese Journal of Oncology
基金 首都临床特色应用研究(Z171100001017211)。
关键词 甲状腺肿瘤 淋巴结转移 超择区性颈淋巴结清扫 Papillary thyroid neoplasms Lymph node metastasis Super-selective neck lymph node dissection
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