Department of General Surgery, Zhejiang University, Hangzhou, China.
Surg Endosc. 2011 Mar;25(3):890-6. doi: 10.1007/s00464-010-1292-7. Epub 2010 Aug 24.
Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) requires a large incision to obtain adequate exposure of the surgical field, leaving an unsightly scar. We applied scarless (in the neck) endoscopic thyroidectomy (SET) via breast approach to lateral neck dissection for PTC and evaluated its feasibility and safety.
Between July 2007 and October 2009, 11 T1 (tumor size not exceeding 2 cm) low-risk PTC female patients with suspected lymph node metastasis at level III or IV were selected for this procedure. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level III and IV dissection via breast approach was performed. The steps of endoscopic lateral neck dissection were similar to that of conventional surgery except that the lateral cervical compartment was exposed by splitting the sternocleidomastoid muscles (SCM) longitudinally.
This procedure was carried out successfully in all 11 patients. Mean operative time for lateral neck dissection was 94.3 min (range 77-123 min). No significant blood loss or complications occurred. Average postoperative hospital stay was 4.3 days (range 3-6 days). Ten patients had lymph node metastasis in both central and lateral zones, while one patient had central zone metastasis only. Mean lymph node yield in the lateral compartment was 18.3 (range 9-26). No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent.
Endoscopic lateral neck dissection via breast approach is feasible and safe with excellent cosmetic results for selected cases of PTC. Further study based on large comparative series and long-term follow-up is needed to verify its oncological validity.
对于患有甲状腺乳头状癌（PTC）的患者，传统的开放式颈侧区清扫术需要大切口以获得足够的手术视野暴露，从而留下难看的疤痕。我们应用经乳晕入路无疤痕（颈部）内镜甲状腺切除术（SET）进行 PTC 的颈侧区清扫，并评估其可行性和安全性。
在 2007 年 7 月至 2009 年 10 月期间，选择了 11 名 T1（肿瘤大小不超过 2cm）低危 PTC 女性患者，这些患者怀疑有 III 或 IV 水平的淋巴结转移。完成甲状腺切除术和中央隔室解剖后，通过乳晕入路对同侧 III 和 IV 区进行解剖。内镜颈侧区清扫的步骤与传统手术相似，只是通过将胸锁乳突肌（SCM）纵向劈开来暴露颈侧区。
所有 11 名患者均成功完成了该手术。颈侧区清扫的平均手术时间为 94.3 分钟（77-123 分钟）。无明显失血或并发症发生。平均术后住院时间为 4.3 天（3-6 天）。10 例患者中央和侧区均有淋巴结转移，1 例患者仅中央区转移。侧区的平均淋巴结产量为 18.3（9-26）个。随访时无残留或复发病灶证据。该手术的美容效果极佳。
对于选定的 PTC 病例，经乳晕入路内镜颈侧区清扫术是可行且安全的，美容效果极佳。需要进一步基于大的比较系列和长期随访的研究来验证其肿瘤学的有效性。
