Fujiwara Kazunori, Fukuhara Takahiro, Koyama Satoshi, Donishi Ryohei, Kataoka Hideyuki, Kitano Hiroya, Takeuchi Hiromi
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
Case Rep Oncol. 2017 Jul 14;10(2):649-655. doi: 10.1159/000478653. eCollection 2017 May-Aug.
Endoscopic-assisted transoral surgery, including transoral robotic surgery for metastatic retropharyngeal lymph node (RPN) from well-differentiated thyroid cancer, has been reported to reduce the complications resulting from transcervical and transmandibular approaches. However, the narrow working space and difficulty identifying RPN are problematic. To solve these issues, several studies have used intraoperative ultrasound in endoscopic-assisted transoral surgery. However, the type of ultrasonography suitable for this purpose remains unclear.
A 60-year-old female with thyroid papillary carcinoma (T4aN1bM0) initially underwent total thyroidectomy and paratracheal and selective neck dissections (D2a), with resectional management of recurrent laryngeal nerve, trachea, and esophagus. Three years later, she was diagnosed with left retropharyngeal and upper mediastinal lymph node metastases of papillary thyroid cancer. Transoral videolaryngoscopic surgery was performed with a combination of ultrasonography with a flexible laparoscopic transducer manipulated with forceps for identifying RPN intraoperatively. Due to the transducer's small size and thin, flexible cable, the transducer interrupted the procedure in spite of the narrowness of oral cavity. RPN was resected completely without adverse events.
We performed intraoperative ultrasound-guided endoscopic transoral surgery for metastatic RPN from papillary thyroid cancer and achieved complete resection as well as preservation of swallowing function.
据报道，内镜辅助经口手术，包括用于分化型甲状腺癌转移性咽后淋巴结（RPN）的经口机器人手术，可减少经颈和经下颌入路引起的并发症。然而，工作空间狭窄和难以识别RPN是个问题。为了解决这些问题，一些研究在内镜辅助经口手术中使用了术中超声。然而，适合此目的的超声检查类型仍不清楚。
一名60岁女性，患有甲状腺乳头状癌（T4aN1bM0），最初接受了全甲状腺切除术、气管旁和选择性颈部清扫术（D2a），并对喉返神经、气管和食管进行了切除处理。三年后，她被诊断为甲状腺乳头状癌左咽后和上纵隔淋巴结转移。采用经口视频喉镜手术，结合使用带钳操作的柔性腹腔镜探头进行术中超声检查以识别RPN。由于探头尺寸小且电缆细而灵活，尽管口腔狭窄，探头仍干扰了手术操作。RPN被完全切除，无不良事件发生。
我们对甲状腺乳头状癌转移性RPN进行了术中超声引导下的内镜经口手术，实现了完全切除并保留了吞咽功能。
