Sako K, Marchetta F C, Razack M S, Shedd D P
Am J Surg. 1985 Oct;150(4):500-2. doi: 10.1016/0002-9610(85)90163-1.
From January 1958 through December 1983, 56 modified radical neck dissections were performed on 47 patients with metastases to the cervical nodes from differentiated carcinomas of the thyroid. In nine patients, a second modified radical neck dissection was performed either simultaneously or at a later date. Lymph node clearance was performed on all but one surgical specimen. The number of nodes in each specimen ranged from 10 to 96, and the number of involved nodes ranged from 1 to 20. Thirty-eight of the 56 neck specimens contained four or more positive nodes. Seventeen patients were followed for 10 to 26 years, 18 patients for 5 to 9 years, and 5 patients for less than 5 years. Seven other patients died, three from other causes and four from lung metastases. There were no recurrences in the neck sides that would have been cleared if standard radical neck dissection had been performed. This reappraisal with long-term follow-up supports our initial impression that a modified radical neck dissection sparing the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, or any combination thereof is an effective procedure for differentiated cancer of the thyroid, with preservation of good shoulder function and improvement in the cosmetic appearance of the neck.
1958年1月至1983年12月，对47例甲状腺分化癌颈部淋巴结转移患者施行56例改良根治性颈清扫术。9例患者同时或随后接受了第二次改良根治性颈清扫术。除1个手术标本外，对所有标本均进行了淋巴结清扫。每个标本中的淋巴结数量为10至96个，受累淋巴结数量为1至20个。56个颈部标本中有38个含有4个或更多阳性淋巴结。17例患者随访10至26年，18例患者随访5至9年，5例患者随访时间不足5年。另有7例患者死亡，3例死于其他原因，4例死于肺转移。如果施行标准根治性颈清扫术，颈部清扫侧未出现复发。这种长期随访的重新评估支持了我们最初的印象，即保留副神经、胸锁乳突肌、颈内静脉或其任何组合的改良根治性颈清扫术对甲状腺分化癌是一种有效的手术方法，可保留良好的肩部功能并改善颈部外观。
