分化型甲状腺癌选择性颈淋巴结清除术的临床应用

目的探讨分化型甲状腺癌选择性颈淋巴结清除术的手术指征、手术方法和结果。方法参照美国头颈外科协会颈淋巴结分区法和手术指南,前瞻性的对2004年1月至2006年6月的40例早中期（Ⅰ期35例,Ⅱ期2例,Ⅲ期3例）分化型甲状腺癌患者施行甲状腺切除加选择性颈淋巴结清除术（42例次）。对患者的手术指征、手术方法、并发症和术后颈淋巴结的病理结果进行分析。结果40例中,9例仅行中央组（Ⅵ组）清除;24例（57％）的清除范围≤3组,且均采用普通颈部横切口。总的淋巴结阳性率为67％（28／42）。其中,Ⅵ组阳性率为58％（23／40）、Ⅳ组为48％（16／33）、Ⅲ组为48％（14／29）、Ⅱ组为50％（7／14）、Ⅴ组为27％（4／15）。Ⅵ组阳性率与Ⅳ、Ⅲ和Ⅱ组相比差异无统计学意义（P〉0．05）。20％（8／40）的标本中找到1枚误切的甲状旁腺;27％（11／40）的患者有一过性低钙表现,无永久性者;7．5％（3／40）有短暂性喉返神经麻痹,无永久性者。19例随访时间超过6个月者,6个月时颈部超声未见肿大淋巴结。结论选择性颈淋巴结清除术对早中期分化型甲状腺癌患者实施是合理的。

Investigation of selective neck dissection for differentiated thyroid cancer

OBJECTIVE: To investigate the indication, operative method and results of selective neck dissection (SND) for differentiated thyroid cancer. METHODS: According to the level system and the operative guideline of the American Head and Neck Society, 40 cases of thyroid cancer (phase I: 35 cases, phase II: 2 cases, phase III: 3 cases) were collected prospectively. Thyroidectomy plus SND was performed on all the cases. And the indication, operative methods and results were investigated. RESULTS: Nine of the 40 cases received level VI dissection only. Twenty-four of the 40 cases received SND with levels 0.05). One parathyroid was found in 20% (8/40) of the specimen and 27% (11/40) of the patients had transient hypocalcemia, but no permanent hypocalcemia. Three (7.5%) of the patients had vocal cord paralysis for a short period of time and no permanent case was detected. Nineteen patients were followed up for more than 6 months after the operation and no enlarged neck lymph node was found by ultrasound at the 6th month postoperatively. CONCLUSION: It is reasonable to give SND to the early thyroid cancer patients.