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目的探讨分化型甲状腺癌颈淋巴结清扫术的手术入路。方法回顾性分析2008年12月-2011年7月新疆医科大学附属肿瘤医院乳腺头颈外科进行保留颈丛皮神经颈淋巴结清扫术(即保留颈丛皮神经的Ⅱ、Ⅲ、Ⅳ、Ⅵ区清扫)的58分化型甲状腺癌患者临床资料,其中26例采用颈部两切口(两切口组),32例采用颈部“L”型切口(传统“L”型切口组)分别进行颈淋巴结清扫,所有患者均由同一组手术人员完成。并对两组患者手术效果、手术时间、出血量、有无皮瓣坏死、颈部有无积液、颈部水肿程度、瘢痕程度及功能障碍等与手术相关的并发症进行对比。结果两切口组26例甲状腺癌患者手术均顺利完成,无一例需改用其他方式颈淋巴结清扫,与传统“L”型切口组比较,手术时间、出血量、颈部淋巴漏未见增多,皮瓣坏死、颈部水肿程度、瘢痕程度及功能障碍明显减少。术后随访1.5～31个月未出现局部及颈部淋巴结复发。结论颈部两切口颈淋巴结清扫术不增加相关并发症,其在不影响颈淋巴结清扫效果的同时又兼顾了功能与美容,是甲状腺癌保留颈丛皮神经的Ⅱ、Ⅲ、Ⅳ、Ⅵ区域淋巴结清扫的一种较为理想的手术入路。
Objective To investigate the surgical approach of cervical lymph node dissection in differentiated thyroid cancer. Methods A retrospective analysis was performed between December 2008 and July 2011 in the Department of Breast and Neck Surgery, Cancer Hospital Affiliated to Xinjiang Medical University to conserve the cervical lymph nodes of the cervical plexus (ie, to keep the cervical cords and brains of the nerves Ⅱ, Ⅲ, Ⅳ and Ⅵ) Of the 58 patients with differentiated thyroid cancer clinical data, including 26 cases of the neck with two incisions (two incision group), 32 patients with the neck “L ” incision (traditional “L ” incision group) Lymph node dissection, all patients by the same group of surgeons to complete. The surgical outcomes, operative time, bleeding volume, presence or absence of flap necrosis, neck fluid, neck edema, degree of scarring, and dysfunction were compared between the two groups. Results The operation of 26 thyroid cancer patients in both incision groups was successfully completed. None of them had to be replaced by other methods of cervical lymph node dissection. Compared with the traditional “L” type incision group, there was no increase in operation time, blood loss and cervical lymph node leakage , Flap necrosis, neck edema, degree of scarring and dysfunction were significantly reduced. Followed up 1.5 to 31 months after surgery did not appear local and cervical lymph node recurrence. Conclusions Both neck and neck lymph node dissection do not increase the related complications. It does not affect the function of cervical lymph node dissection while taking into account the function and beauty. It is the second, third, fourth and sixth regional lymph nodes An ideal surgical approach to cleaning.