Ardito G, Revelli L, Ardito F, Moschella F, Centritto E M, Lo Schiavo V, Rulli F
Dept. of Surgery, Catholic University of Sacred Heart, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4):539-41.
The purpose of this study was to describe an alternative lateral neck access to perform lymph nodes sampling and/or neck dissection via extra-thyroideal space (MRND vets) in papillary thyroid carcinoma with lymph nodes involvment. Twenty-four consecutive patients with papillary thyroid carcinoma were included. Lymph nodes sampling and modified radical neck dissection, unilateral or bilateral, were performed acceding via a lateral dissection through a traditional Kocher incision, running along the medial fascia of the neck, posteriorly to the sterno-cleido-mastoideus muscle (SCM). Mean age was 39.04 +/- 13.69 years. Twenty patients were women, and 4 were men. Mean tumor size was 2.5 +/- 1 cm.. Total thyroidectomy with lymph nodes dissection of the central compartment associated to modified radical neck dissection was performed in 17 patients: among these, nine patients had a preoperative diagnosis of the latero-cervical lymph nodes metastases, and eight had a perioperative diagnosis of metastases of the extensive sampling of the lower third of the jugular chain. Metastatic lymph nodes were found in 107 out of 615 lymph nodes dissected. The MNRD vets access for modified lateral neck dissection seems to carry a lower risk in terms of specific morbility and allows a quicker recovery and a better cosmetic result. This access has to be considered as a less invasive procedure compared to other surgical accesses for the radical modified lateral neck dissection.
本研究的目的是描述一种替代性的侧颈入路，用于对伴有淋巴结受累的乳头状甲状腺癌患者，经甲状腺外间隙进行淋巴结取样和/或颈清扫术（改良根治性颈清扫术，MRND vets）。纳入了连续24例乳头状甲状腺癌患者。通过沿颈部内侧筋膜、胸锁乳突肌（SCM）后方的传统科赫尔切口进行外侧解剖，进行淋巴结取样和单侧或双侧改良根治性颈清扫术。平均年龄为39.04±13.69岁。20例为女性，4例为男性。平均肿瘤大小为2.5±1cm。17例患者进行了全甲状腺切除术，同时进行中央区淋巴结清扫并联合改良根治性颈清扫术：其中，9例患者术前诊断为侧颈淋巴结转移，8例患者在术中对颈静脉链下三分之一进行广泛取样时诊断为转移。在615个清扫的淋巴结中，发现107个有转移淋巴结。改良侧颈清扫术的MRND vets入路在特定发病率方面似乎风险较低，且恢复更快、美容效果更好。与其他用于改良根治性侧颈清扫术的手术入路相比，该入路应被视为一种侵入性较小的手术方法。
