在甲状腺乳头状癌中施行保留颈丛的改良颈清扫术

目的探讨保留颈丛的功能性颈清扫术在分化性甲状腺癌手术中的临床应用。方法回顾性分析18例施行保留颈丛的改良性颈淋巴结清扫的甲状腺乳头状癌患者的临床资料，选取同期的甲状腺癌颈淋巴结转移行不保留颈丛的改良性清扫的患者20例，观察并比较两组术后出现相应颈丛损伤的功能障碍发生率。结果保留颈丛者出现局部麻木者耳垂区22．2％（4／18）、颈部16．7％（3／18）、锁骨区16．7％（3／18），不保留颈丛组出现局部麻木者耳垂区100．0％（20／20）、颈部55．0％（11／20）、锁骨区55．0％（11／20）。前者功能障碍的发生率明显低于后者（P〈O．05）。结论保留颈丛的改良性颈清扫术在甲状腺乳头状癌手术中不会增加淋巴结转移率．有效地保留了耳垂区、颈部、锁骨区的感觉，提高了患者的生存质量。

Modified neck dissection with the preservation of cervical plexus for the patients with thyroid papillary carcinoma

Objective To explore clinical application of the functional neck dissection preserving cervical plexus in the thyroid papillary carcinoma. Methods 18 cases with thyroid papillary carcinoma cases received modified neck dissection with the preservation of cervical plexus were analyzed retrospectively. Modified neck dissection without the preservation of cervical plexus was performed in 20 patients with thyroid carcinoma at the same time. The incidence of disfunction in correspondence with postoperative cervical plexus impairment was compared between two groups. Results The rate of local numbness of auricular lobule region, neck, clavicular region were 22.2% （4/ 18）, 16.7%（3/18）, 16.7% （3/18）respectively in the patients with the preservation of cervical plexus. The rate of local numbness of auricular lobule region,neck,clavicular region were 100.0% （20/20）, 55.0% （11/20）, 55.0% （11/20）respectively in patients without the preservation of cervical plexus.The rate of disfunction of the former was significantly lower than that the latter （P〈0.05）. Conclustion The preservation of cervical plexus in modified neck dissection for thyroid papillary carcinoma does not increase the recurrence of the lymph node metastasis. However, it can protect the sensation of ears, lower necks, upper shoulders and improve the survival quality of patients.