甲状腺癌颈淋巴结清扫联合迷走神经、桡神经浅支Ⅰ期吻合修复术1例

Cervical lymph node dissection in combination with phase I anastomosis repair of vagus nerve and superficial branch of radial nerve of thyroid cancer:a case report

甲状腺乳头状癌临床上常见,生长缓慢,属于惰性肿瘤,较少侵犯周围神经。本文介绍1例患者因发现左颈部肿物伴声音嘶哑入院,颈部B超和CT提示双侧甲状腺结节恶性伴左侧颈部淋巴结转移,喉镜提示左侧声带麻痹。行常规双侧甲癌标准根治术+左侧根治性颈淋巴结清扫术,术中发现左颈中上群淋巴结侵犯迷走神经及颈内静脉,遂切除侵犯段神经和血管,于前臂锐性游离并离断桡神经浅支长约6.5 cm,将其移植于颈段缺失迷走神经处。术后恢复良好,未发生饮水呛咳、吞咽困难。

Papillary thyroid cancer is a clinically common,slow-growing,inert tumor that rarely invades peripheral nerves.A patient was admitted to the hospital due to left neck mass with hoarseness.Cervical B-ultrasound and CT showed bilateral malignant thyroid nodules with left cervical lymph node metastasis.Laryngoscopy indicated left vocal cord paralysis.Conventional standard radical operation for bilateral thyroid cancer plus left radical neck lymph node dissection was performed.During the operation,it was found that the vagus nerve and internal jugular vein were invaded by the left middle and upper cervical lymph nodes.The invaded nerves and blood vessels were resected.The superficial branch of the radial nerve,about 6.5 cm,was sharply dissociated and severed in the forearm,then was transplanted to the missing vagus nerve in the cervical segment.The patient recovered well after operation without coughing due to drinking water and difficulty in swallowing.