分化型甲状腺癌全腔镜下择区性颈侧区清扫的发展

Development of total endoscopic selective lateral neck dissection in differentiated thyroid cancer

甲状腺乳头状癌具有较高的淋巴结转移率,且存在顺序转移和淋巴结内转移的特性。《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》中提出“择区性清扫”概念,为全腔镜下颈侧区清扫手术提供了理论基础。全腔镜下颈侧区淋巴结清扫与传统的开放手术相比,具有较好的美容效果。在多种入路中,经胸前入路因操作简单、安全可行和适应证范围大等优点获得了广泛的认可。多年的实践探索显示,经胸前入路四区七步择区清扫方法通过实施标准化的手术操作和并发症管理,可达到与开放手术相同的清扫效果,而不增加并发症发生率。对于年轻有美容需求的患者,此术式有广阔的临床应用前景。

In recent years,the consensus has confirmed the high lymph node metastasis rate of thyroid papillary cancer(PTC)and the characteristics of its sequential metastasis and intranodal metastasis.Guidelines for the diagnosis and management of thyroid nodules and differentiated thyroid cancer(second edition)proposed the concept of“selective lymph node dissection”,a strategy that provides a promising outlook for endoscopic lateral neck dissection for PTC.Among various approaches,the transthoracic approach has been widely recognized for its simplicity,safety,feasibility,and wide range of indications.Years of practical exploration have shown that the four-zone seven-step selective dissection method through the transthoracic approach can achieve the same effect as open surgery without increasing the incidence of related complications.Therefore,for young patients with cosmetic needs,this operation has a very broad clinical prospective.