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目的总结领式切口保留颈丛的择区性颈部淋巴结清扫术在分化型甲状腺癌中的应用和经验。方法复旦大学附属肿瘤医院头颈外科2009年1月至2010年12月期间对112例临床考虑颈侧区转移(CN1b)甲状腺癌病人在原发灶根治的同时施行了领式切口保留颈丛的择区性颈部淋巴结清扫术。结果颈部淋巴结转移主要分布在Ⅵ区(78.8%)、Ⅳ区(72.9%)、Ⅲ区(60.2%)、Ⅱ区(43.8%)和ⅤB区(16.9%)。病人术后均无明显耳部、下颈部和肩部感觉异常。术后经1～25个月随访无局部复发。结论对于临床考虑颈侧区转移(CN1b)或穿刺证实颈侧区转移的分化型甲状腺癌,在没有ⅤA区转移或没有淋巴结明显外侵的首次手术病人,领式切口保留颈丛的择区性颈清扫可以作为替代根治性或改良性颈清扫的一种选择。
OBJECTIVE: To summarize the experience and application of neck-neck selective cervical lymph node dissection in differentiated thyroid cancer. Methods Head and Neck Surgery, Affiliated Tumor Hospital, Fudan University From January 2009 to December 2010, 112 cases of thyroidectomy with CN1b metastasis undergoing primary radical resection were treated with collar incision to preserve cervical plexus Regional neck lymph node dissection. Results Cervical lymph node metastasis was mainly found in Ⅵ (78.8%), Ⅳ (72.9%), Ⅲ (60.2%), Ⅱ (43.8%) and ⅤB (16.9%). The patient had no obvious postoperative ear, neck and shoulder under the unusual feeling. After 1 to 25 months after follow-up no local recurrence. Conclusions For patients with differentiated thyroid carcinomas who have clinically considered metastasis to the neck (CN1b) or metastasis to the cervical side of the neck, the collar-type incision retains the cervical plexus in the first-time surgical patients who have no metastases to the VA region or have no significant invasion of the lymph nodes Neck dissection can be used as an alternative to radical or modified neck dissection.