甲状腺癌行弧形切口颈部淋巴结清扫术临床分析

目的探究低位弧形切口在甲状腺乳头状癌(PTC)功能性颈部淋巴结清扫术中的应用可行性及安全性。方法回顾性分析2012年3月至2014年3月200例PTC伴有颈部淋巴结转移手术患者的临床资料。根据切口形状的不同分为低位组(132例)和传统组(68例),采用SPSS 19.0软件,对两组患者切口长度、淋巴结清扫数目及术后生活质量和外观满意度等连续变量分析使用t检验;术后并发症及复发情况的比较选用χ~2检验,P0.05认定为有统计学意义。结果低位组在手术用时、切口长度均较传统组短(P0.05);在其他颈侧区淋巴结清扫数目上两组间没有明显差别(P0.05),但在Ⅱb区和Ⅴ区淋巴结数目低位组却少于传统组(P0.05)。在切口瘢痕色泽、厚度、柔软程度、血管分部和患者肩部僵硬感、疼痛、麻木感等方面低位组得分均低于传统组(P0.05)。淋巴结转移累及Ⅱa区时,Ⅱb区转移风险增高(r=0.183,P0.001);多区转移时,Ⅱb和Ⅴ区转移风险均增高(r=0.241、0.242,P0.001)。结论低位弧形切口PTC功能性颈部淋巴结清扫术安全可行,并可以明显改善患者术后生活质量,但对Ⅱb区和Ⅴ区以及多区转移的患者,建议仍采用传统的"L"形切口进行手术。

Clinical analysis of cervical lymph node dissection by using low-transverse arc collar incision for thyroid carcinoma

Objective To explore the feasibility and safety of cervical lymph node function-preserving dissection by using low-transverse arc collar incision for Papillary thyroid carcinomas ( PTC ) . Methods From March 2012 to March 2014, clinical data of 200 patients with PTC and cervical lymph node metastases were analyzed retrospectively .According to the difference of the shape of incision , patients were divided into low-incision group (132 cases) and traditional-incision group (68 cases).Statistical analysis were performed by using SPSS 19.0 software.Continuous variables in two groups , including incision length , lymph node dissection number , postoperative life quality and satisfaction of the appearance , were examined by using t-test.Postoperative complications and recurrence were examined by using chi square test .P value less than 0.05 was considered as significant difference . Results The operation time and length of incision in low-incision group was shorter than that in conventional-incision group , with significant difference ( P<0.05).There was no difference of total harvested lymph nodesbetween two groups (P >0.05),however resected lymph nodes of Ⅱb and Ⅴ region in low-incision group were significantly lower than those in conventional-incision group ( P <0.05 ).In comparison with conventional-incision group, postoperative appearance of incision, including color, thickness and vessels, as well as shoulder stiffness, pain and numbness were improved significantly in low-incision group (P<0.05).If metastasis involved Ⅱa region ,Ⅱb region lymph node metastasis would be increased (r=0.183, P<0.001).If metastasis could be found in multiple regions,Ⅱb and Ⅴregions lymph node metastasis would be increased (r=0.241, 0.242, P<0.001). Conclusion cervical lymph node function-preserving dissection by using low-transverse arc collar incision for PTC is safe and feasible , could help to improve postoperative life quality .However , conventional incision should be recommended for patients with IIb or multi-regions metastasis .