采用领式皮纹延长切口进行甲状腺癌颈淋巴结清扫

目的 探索甲状腺癌颈清扫术术后更加美观的手术切口.方法 对82例分化型甲状腺癌患者采用领式皮纹延长切口行改良颈清扫术.在常规甲状腺领式切口的基础上,在颈清扫侧沿皮纹延长到斜方肌前缘位置,避免曲棍球棒切口的垂直段.82例患者共行颈清扫术96侧,术式分别是根治性颈清扫术1侧,改良性颈清扫术Ⅰ型1侧,改良性颈清扫术Ⅱ型8侧,改良性颈清扫术Ⅲ型86侧.结果 采用领式皮纹延长切口患者平均手术麻醉时间为197 min.每侧平均清扫淋巴结37.5枚,平均阳性淋巴结8.8枚.与颈清扫术有关的并发症发生率为9.8%(8/82).淋巴结复发率1.2%,未发生远地转移和死亡.结论 采用领式皮纹延长切口行改良颈清扫术治疗分化型甲状腺癌颈淋巴结转移在技术上可行,肿瘤治疗效果满意,颈部切口瘢痕小,满足了部分患者维护颈部外观的需求.

Application of an extended collar incision in neck dissection for differentiated thyroid cancer

Objective To explore a cosmetic incision in the neck dissection for differentiated thyroid carcinoma. Methods An extended collar incision was used for neck dissection in 82 consecutive patients with thyroid carcinoma from May 1999 to December 2006. The incision was designed to start as a conventional thyroid collar incision, and then to extend it along the skin crease to the anterior border of trapezium, so to avoid the vertical limb of conventional hockey stick incision. There were 60 females and 22 males in this series, with a median age of 40.5 years (range, 10 to 80 years). Ninety-six procedures of neck dissection were performed in 82 patients, including one radical neck dissection, one type Ⅰ modified neck dissection, 8 type Ⅱ modified neck dissections, and 86 type Ⅲ modified neck dissections. Results The average time of anesthesia was 197 minutes. The average dissected lymph nodes were 37.5, with average metastasis in 8.8 nodes. Eight patients (9.8%) developed complications related to neck dissection. The follow-up period in these patients were 1 to 96 months with a median follow-up time of 23 months. Cervical recurrence was found in only one patient (1.2%). Neither death nor distant metastasis was observed in this series. Conclusion It is feasible to perform a modified neck dissection for differentiated thyroid cancer through the extended collar incision. The preliminary results show that the above described incision is not only oncologically safe, but also offers a cosmetic benefit for the patient with thyroid carcinoma.