简化的功能性颈部淋巴结清除术治疗高危甲状腺乳头状癌的临床效果

目的探讨简化的功能性颈部淋巴结清除术治疗高危甲状腺乳头状癌的临床效果。方法对1994年2月-2013年5月收治的高危甲状腺乳头状癌患者80例手术治疗的临床资料进行回顾性分析,其中1994年2月-2011年10月施行功能性颈部淋巴结清扫术50例为FND组,2011年11月-2013年5月施行简化的功能性颈部淋巴结清除术30例为SFND组。术后坚持终生服用甲状腺素片,伴有腺体外浸润的6例给予131I内照射治疗。结果施行患侧腺叶全切除＋峡部切除＋对侧次全切除术71例,双侧甲状腺全切除9例。手术近期并发症共8例（10%）,其中声音嘶哑、乳糜漏、症状性低钙血症发生率,FND组分别为4.0%（2/50）、4.0%（2/50）和2.0%（1/50）,SFND组均为3.3%（1/30）,两组比较差异无统计学意义（P〉0.05）。以3个月-1年为随访期限记录手术远期并发症,FND组与SFND组患侧颈、肩及上肢感觉异常发生率分别为16.0%（8/50）和0,活动障碍发生率分别为14.0%（7/50）和0,两组比较差异有统计学意义（P〈0.05）。结论规范的手术治疗是改善甲状腺乳头状癌患者预后的关键因素,SFND用于高危甲状腺乳头状癌的治疗,有助于保护患侧颈、肩及上肢感觉和运动功能,减少癌复发和转移。

Clinical effect of simplified functional cervical lymph node dissection in the treatment of papillary thyroid carcinoma with high risk of malignant development

Objective To investigate clinical effect of simplified functional cervical lymph node dissection in the treat-ment of papillary thyroid carcinoma with high risk of malignant development. Methods Clinical data of 80 cases of papillary thyroid carcinoma with high risk of malignant development in our hospital from February 1994 to May 2013 were analyzed retrospectively.Functional neck dissection （FND）was performed in FND group （50 cases）from February 1994 to October 2011.Simplified functional neck dissection（SFND）was performed in SFND group（30 cases）from Novem-ber 2011 to May 2013.Patients took orally thyroxine tablets throughout their life.131I radiotherapy was applied for 6 pa-tients with infiltrating to the outside of the thyroid gland. Results Unilateral thyroidectomy,isthmus resection and oppo-site subtotal thyroidectomy were performed in 71 cases,bilateral thyroidectomy （total thyroidectomy）was used in 9 cases. Early postoperative complication occurred in 8 cases including voice hoarse,chylous fistula and symptomatic hypocal-cemia.Incidence rate of voice hoarse,chylous fistula and symptomatic hypocalcemia in FND group was 4.0%（2/50）,4.0%（2/50）and 2.0%（1/50）respectively.Incidence rate of voice hoarse,chylous fistula and symptomatic hypocalcemia in SFND group was 3.3%（1/30）respectively.There was no statistical difference between FND group and SFND group（P〉0.05）.Du-ration of followed-up for the long-term complication was 3 months to 1 year.Incidence rate of abnormal sen-sation and movement disturbance in the affected side neck,shoulder and upper extremity,incidence rate of in-activity in FND group was 16.0%（8/50）and 14.0%（7/50）.None occurred in SFND group.There was statistical difference between FND group and SFND group （P〈0.05）. Conclusion The standardized surgical treatment is the key point to im-prove prognosis in papillary thyroid cancer with high risk of malignant development.SFND applied in patients with pap-illary thyroid cancer with high risk of mali