颈清扫术在分化型甲状腺癌中的应用探讨

目的探讨不同术式的颈淋巴结清扫术在分化型甲状腺癌中的应用。方法回顾性分析2001年2月~2004年2月216例甲状腺癌颈清扫术的临床资料。结果216例行颈淋巴结清扫术中,改良颈清扫术158例(73.1%),经典性颈清扫术22例(10.2%),选择性淋巴清扫术31例(14.4%),扩大颈清扫术5例(2.3%)。术后喉返神经损伤6例(2.8%),甲状旁腺损伤12例(5.6%),乳糜漏4例(1.9%),食管损伤3例(1.4%)。171例(79.2%)随访3年以上(含3年)104例,复发5例,占随访病例的2.9%;3年无瘤生存率为95.2%(99/104)。结论分化型甲状腺癌伴颈淋巴结转移,应根据病理分型、临床分期及个体化原则选择不同的术式行颈淋巴结清扫。

Application and selection of radical neck dissection for differentiated thyroid carcinoma

Objective To discuss the optimal surgical patterns of cervical lymph node resection for patients with differentiated thyroid car cinoma(DTC) involved jugular lymphatic nodes.Methods Clinical data of 216 cases of DCT involved jugular lymphatic nodes were summarized and analyzed retrospectively.Results Among the 216 cases of cervical lymph node resection,158 cases(73.1%) were treated by modified radical node dissection(MRND),31(14.4%) by selective node dissection(SND),22(10.2.%) by classical node dissection(CND),31(14.4%)by selective clearance of the lymph nodes,5(2.3 %)by enlarged clearance of cervical lymph nodes.Surgical complications were approximately 11.6%(25/216),including larynx nerve lesion in 6 cases,parathyroid gland lesion in 12 cases,esophagus lesion in 3 cases and leak of chyle in 4 cases.Survival rate of 3 years was 95.2%(99/104).Conclusion Surgical patterns for DTC should be instituted according to pathologic typing and clinical staging of the tumors.