Zhang Zong-Min, Xu Zhen-Gang, Li Zheng-Jiang, An Chang-Ming, Liu Jie, Zhu Yi-Ming, Ni Song, Tang Ping-Zhang
Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China. Email:
Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Sep;48(9):712-5.
Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.
Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level II-IV and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level II-V received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level II-IV,VI orII-VI dissection via small neck incision was performed.
This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, N1b 13 cases. Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours). No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 (ranging 16-61). No residual or recurrent disease was found in 2-3 years follow-up time.
Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.
传统开放性手术用于甲状腺乳头状癌（PTC）患者的侧颈淋巴结清扫会留下难看的疤痕。有必要采用小切口并运用内镜技术完成PTC的侧颈淋巴结清扫，并评估其可行性和安全性。
2010年3月至2011年5月，对6例Ⅱ-Ⅳ级无明确淋巴结转移的PTC患者以及12例T1-T4级且Ⅱ-Ⅴ级有明确淋巴结转移的PTC患者进行了微创内镜辅助下侧颈淋巴结清扫。在完成甲状腺切除术和中央区清扫后，经颈部小切口进行同侧Ⅱ-Ⅳ、Ⅵ或Ⅱ-Ⅵ区清扫。
18例患者均成功完成该手术。每位患者的切口为5厘米。术后pT1为5例，pT2为5例，pT3为6例，pT4为2例，pN0为5例，N1b为13例。侧颈淋巴结清扫的平均手术时间为3.6小时（范围为2.5 - 5.0小时）。未发生明显失血或并发症。13例患者在中央区或侧颈均显示有淋巴结转移。平均收获淋巴结数为33.1个（范围为16 - 61个）。在2 - 3年的随访期内未发现残留或复发病灶。
微创视频辅助下转移性甲状腺乳头状癌全颈清扫术是可行且安全的，美容效果良好。
