分层解剖在分化型甲状腺癌功能性颈清术中应用

目的多功能保留颈淋巴结清除术是治疗分化型甲状腺癌(differentiated thyroid cancer,DTC)颈部淋巴结转移的主要方法,较传统的功能性颈清除术更美观性,颈部功能保留更完善。如何更好的完成该手术,降低术后并发症,一直是外科医师探讨的问题。本研究主要探讨分层解剖在DTC多功能保留颈淋巴结清除术中应用的可行性及意义。方法回顾性分析沧州市中心医院2008-05-01—2019-03-31因DTC行甲状腺切除加Ⅱ~Ⅵ区多功能保留颈淋巴结清除术的457例患者临床资料,分为分层解剖法多功能保留手术组(A组,235例)和常规多功能保留手术组(B组,222例)。记录2组的手术学指标、术后并发症和出院时间等。采用χ^2检验及t检验对数据进行分析。结果2组患者基线资料比较,差异均无统计学意义,均P>0.05。A与B组手术时间分别为(127.85±14.65)和(136.80±14.65)min,t=-6.529,P<0.001;出血量分别为(34.38±14.44)和(48.02±18.88)mL,t=-8.705,P<0.001;术后住院时间分别为(8.57±1.41)和(11.59±2.21)d,t=-17.469,P<0.001;差异均有统计学意义。术后并发症发生率A组比B组更少,声音嘶哑发生率分别为1.28%(3/235)和4.50%(10/222),χ^2=4.304,P=0.038;皮缘坏死发生率分别为0.43%(1/235)和4.05%(9/222),χ^2=7.022,P=0.008;低血钙发生率分别为5.11%(12/235)和13.51%(30/222),χ^2=9.668,P=0.002;差异均有统计学意义。结论分层解剖法多功能保留手术不破坏解剖层次界限,明显缩短手术时间,减少术中出血,降低术后并发症发生率。因此其在甲状腺癌多功能保留的颈淋巴结清除术中合理可行。

Application of stratified anatomy in multifunctional cervical dissection for differentiated thyroid cancer

OBJECTIVE Multifunctional neck dissection is the main method for the treatment of differentiated thyroid cancer(DTC)cervical lymph node metastasis.It is more perfect to the traditional functional neck dissection.How to complete the operation better and reduce the postoperative complications has always been a problem discussed by surgeons.The purpose of this study was to investigate the feasibility and significance of stratified anatomy in the application of DTC in the removal of cervical lymph nodes.METHODS The clinical data of 457 patients in Cangzhou Central Hospital from May 1,2008 to March 31,2019 who underwent thyroidectomy plusⅡ-Ⅵregion multi-functional neck lymph node dissection due to DTC were analyzed retrospectively.They were divided into 2 groups,235 patients in multifunctional preservation operation group with stratified anatomy(A group)and 222 patients in the conventional multifunctional preservation operation group(B group).The operative indexes,postoperative complications and discharge time of the two groups were recorded.χ^2 test and t test were used to analyze the data.RESULTS The baseline information was not significantly different between the two groups(all P>0.05).Compared with group B,the operation time of group A was(127.85±14.65)min and(136.80±14.65)min(t=-6.529,P<0.001);the bleeding volume was(34.38±14.44)and(48.02±18.88)mL(t=-8.705,P<0.001);the hospitalization time after operation was(8.57±1.41)and(11.59±2.21)d(t=-17.469,P<0.001);the difference was statistically significant.The morbidity of postoperative complication in group A was less than that in group B.The morbidity of hoarseness was 1.28%(3/235)and 4.50%(10/222)(χ^2=4.304,P=0.038);the morbidity of necrosis of the skin margin was 0.43%(1/235)and 4.05%(9/222)(χ^2=7.022,P=0.008);the morbidity of hypocalcemia was 5.11%(12/235)and 13.51%(30/222)(χ^2=9.668,P=0.002),which all were significant differend.CONCLUSION Stratified anatomy in multifunctional preservation operation can not destroy the anatomical level,significantly shorten the operation time,reduce intraoperative blood loss and the morbidity of postoperative complications.Therefore,it is reasonable and feasible in multifunctional preservation neck dissection of thyroid cancer.