Department of Head and Neck Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China.
J Int Med Res. 2022 Mar;50(3):3000605221078409. doi: 10.1177/03000605221078409.
Advanced thyroid cancer with upper mediastinal lymph node metastasis is not rare in the clinical setting. For patients with severe metastasis, a thoracocervical incision is usually performed for dissection of lymph nodes. However, the difficult operation of three-port thoracoscopy to support performance of a cervical incision in the treatment of upper mediastinal lymph node metastasis has rarely been reported to date. We herein describe a case involving the treatment of thyroid cancer with upper mediastinal lymph node metastasis. The lymph node metastasis was severe, closely adhered to the innominate vein, and fused into a mass. Thoracoscopy with a cervical incision was performed and proved to be a highly difficult surgical maneuver. The patient recovered quickly after the operation. Repeat computed tomography showed no swollen metastatic lymph nodes, indicating that the dissection was thorough. Thoracoscopy with a neck incision is more difficult than conventional longitudinal split sternotomy in the treatment of upper mediastinal lymph node metastasis, but its advantages are less severe trauma and faster recovery. This procedure may be performed by surgeons with proficient skill in cervical surgery and thoracoscopy techniques.
临床上并不罕见甲状腺癌伴上纵隔淋巴结转移的病例。对于转移严重的患者，通常行颈胸切口进行淋巴结清扫。然而，三孔胸腔镜辅助行颈切口治疗上纵隔淋巴结转移的操作难度较大，目前鲜有报道。本文介绍了 1 例甲状腺癌伴上纵隔淋巴结转移的治疗病例。该患者的淋巴结转移严重，与无名静脉紧密粘连并融合成团。我们采用胸腔镜辅助颈切口进行治疗，证实该手术操作难度极大。术后患者恢复迅速。重复 CT 检查显示转移性肿大的淋巴结无复发，提示清扫彻底。与传统的胸骨正中劈开术相比，颈切口胸腔镜手术治疗上纵隔淋巴结转移难度更大，但具有创伤更小、恢复更快的优点。对于熟练掌握颈部手术和胸腔镜技术的外科医生来说，该手术是可行的。
