Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China.
Ann R Coll Surg Engl. 2022 Sep;104(8):e227-e231. doi: 10.1308/rcsann.2021.0104. Epub 2022 Jun 17.
Superior mediastinal lymph node metastases in papillary thyroid cancer are uncommon. The clinical characteristics and surgical strategy of superior mediastinal lymph node metastases remain unclear. Superior mediastinal lymphadenectomy can be accomplished either by a transcervical or transsternal approach. Transsternal approach for superior mediastinal lymphadenectomy can cause great damage; transcervical approach sometimes results in inadequate exposure. Here we report our experience of a papillary thyroid cancer patient with superior mediastinal lymph node metastases who underwent video-assisted superior mediastinal lymphadenectomy. A 49-year-old woman diagnosed with papillary thyroid cancer in left thyroid underwent unilateral lobectomy and ipsilateral central and lateral node dissection in the local hospital 4 years ago. Currently lymph node metastases were found in mediastinum and the right neck, some of which were adjacent to the right innominate vein. Unilateral lobectomy, ipsilateral central and lateral node dissection, and video-assisted superior mediastinal lymphadenectomy were successfully performed by transcervical approach. Subsequently, the patient received thyroxine suppression therapy and adjuvant radioiodine treatment. Video-assisted superior mediastinal lymphadenectomy, providing adequate exposure for a complete superior mediastinal lymphadenectomy, is proved to be safe and feasible.
甲状腺乳头状癌的上纵隔淋巴结转移并不常见。上纵隔淋巴结转移的临床特征和手术策略仍不清楚。上纵隔淋巴结清扫术可经颈入路或胸骨后入路完成。胸骨后入路行上纵隔淋巴结清扫术可造成较大损伤；经颈入路有时会导致显露不足。本文报告了 1 例甲状腺乳头状癌伴上纵隔淋巴结转移患者行电视辅助上纵隔淋巴结清扫术的经验。1 例 49 岁女性，4 年前于当地医院诊断为左侧甲状腺乳头状癌，行患侧甲状腺叶切除术及同侧中央区和侧颈区淋巴结清扫术。目前发现纵隔和右侧颈部淋巴结转移，部分与右侧无名静脉相邻。经颈入路成功完成了单侧甲状腺叶切除术、同侧中央区和侧颈区淋巴结清扫术及电视辅助上纵隔淋巴结清扫术。随后，患者接受了甲状腺素抑制治疗和辅助放射性碘治疗。电视辅助上纵隔淋巴结清扫术为完成完整的上纵隔淋巴结清扫术提供了充分的显露，被证明是安全可行的。
