经胸经口联合入路腔镜甲状腺癌颈侧区淋巴清扫手术10例临床分析

Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma:a report of 10 cases

目的:探讨经胸经口联合入路腔镜甲状腺癌颈侧区淋巴清扫手术的可行性。方法:回顾性分析2015年2月至2019年4月厦门大学附属中山医院普通外科收治,行经胸经口联合入路腔镜甲状腺癌颈侧区淋巴清扫术的10例cN1b期甲状腺乳头状癌(PTC)患者的病例资料,其中男1例,女9例,年龄22~53岁。手术方式为经胸入路行甲状腺全切除术加患侧中央区淋巴清扫术,并行患侧Ⅱ、Ⅲ、Ⅳ区淋巴清扫术,随后经口入路追加补充淋巴清扫。总结患者的一般资料、手术时间、出血量、并发症及术后随访情况等。采用SPSS 22.0软件包对患者的临床数据进行统计学处理。结果:手术均顺利完成,无中转开放手术。10例患者的手术时间为(362.5±79.7)min,出血量为(23.0±14.9)ml,术后住院天数为(5.1±1.3)d。颈侧区淋巴结获得总数(34.2±25.8)枚,阳性淋巴结总数(6.5±4.9)枚。有6例患者通过经口入路补充清扫出淋巴结,其中2例患者经口入路补充清扫出颈侧区淋巴结共9枚,其中3枚为阳性淋巴结。术后3例患者出现短暂性下颌区域皮肤麻木感,于2周内恢复;1例患者出现暂时性的甲状旁腺功能减退,于2个月内恢复;无二次出血、喉返神经麻痹、乳糜漏、颈部感染、永久性甲状旁腺功能减退等并发症。随访时间中位数为42.5个月(16~66个月),期间未出现肿瘤复发、转移,且患者胸部、颈部和口腔无明显外观畸形,无感觉及活动异常。结论:经胸经口联合入路腔镜甲状腺癌颈侧区淋巴清扫术具有安全性和可行性,美容效果显著。

Objective To investigate the feasibility of endoscopic lateral neck dissection via the breast and transoral approaches(ELNDBTOA)for papillary thyroid carcinoma(PTC).Methods From February 2015 to April 2019,10 patients with PTC(cN1b)including 1 male and 9 females aged from 22 to 53 years old received ELNDBTOA in the General Surgery Department of Zhongshan Hospital,Xiamen University.Total thyroidectomy,the central lymph node dissection and the selective neck dissection(levelsⅡ,ⅢandⅣ)were performed endoscopically via the breast approach,and then the residual lymph nodes were dissected via transoral approach.The medical records,operation time,blood loss,complications and postoperative follow-up outcomes were analyzed retrospectively.SPSS 22.0 software package was used for statistical processing of clinical data of patients.Results All cases were successfully treated with ELNDBTOA without transfer to open surgery.The average operative time was(362.5±79.7)min,the blood loss was(23.0±14.9)ml,and the postoperative hospital stay was(5.1±1.3)days.The mean number of harvested cervical lymph nodes were(34.2±25.8),and the mean number of positive lymph nodes were(6.5±4.9).Lymph nodes were dissected by the further dissection via oral approach in 6 patients and a total of 9 lateral lymph nodes were havested from 2 of the 6 patients,with 3 positive lymph nodes.Two patients had transient skin numbness in the mandibular area and recovered within two weeks.One patient developed transient hypoparathyroidism and recovered within two months.No secondary bleeding,recurrent laryngeal nerve paralysis,chylous leakage,neck infection,permanent hypoparathyroidism or other complications were observed.The follow-up time was from 16 to 66 months with a median of 42.5 months,no tumor recurrence or metastasis occurred,and also no obvious deformity,abnormal sensation or movement in the chest,neck and mouth was observed.Conclusions ELNBTOA is safe and feasible,with good cosmetic outcome.