中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2011年
2期
103-105
,共3页
章阳%崔兆清%孙善平%任玉波%许俊龙%姚玉民%陈启%张伟%李蕊%关众%焦德%李文磊%周长鑫
章暘%崔兆清%孫善平%任玉波%許俊龍%姚玉民%陳啟%張偉%李蕊%關衆%焦德%李文磊%週長鑫
장양%최조청%손선평%임옥파%허준룡%요옥민%진계%장위%리예%관음%초덕%리문뢰%주장흠
分化型甲状腺癌%淋巴结转移%简化甲状腺癌改良根治术
分化型甲狀腺癌%淋巴結轉移%簡化甲狀腺癌改良根治術
분화형갑상선암%림파결전이%간화갑상선암개량근치술
Differentiated thyroid carcinoma%Lymphatic metastasis%Simplified modified radical thyroidectomy
目的 探讨分化型甲状腺癌行简化甲状腺癌改良根治术的合理性及I临床应用价值.方法 自2007年1月至2010年6月在标准甲状腺癌改良根治术基础上简化操作过程(简称简化术式)治疗分化型甲状腺癌317例(349侧).简化术式采取颈根部低位弧形顺皮纹小切口(约10～12 cm),分离上下皮瓣,但不在皮下游离患侧胸锁乳突肌后缘及颈后三角皮下区域,可保护诸多通过这些区域穿出的感觉神经.无论原发灶大小、有无患侧颈部淋巴结转移的证据,均行甲状腺患侧叶+峡部+对侧叶次全切除术,并在患侧胸锁乳突肌深面清除主要转移区域(Ⅱ a、Ⅲ、Ⅳ、Ⅴb区)的软组织.不常规显露副神经,以减轻对副神经的刺激.分组检测各区淋巴结转移率,比较不同术式术后并发症.结果简化术式避免了传统的"L"型或弧形长切口造成的明显疤痕及颈部活动受限的弊端;由于保留了全部肌肉及几乎全部神经支配,明显减轻或消除患侧颈肩部活动障碍及痛、麻、胀等异常感觉;缩短手术时间;全面了解颈部淋巴结状态,可准确评价病变的临床病理分期,为判断预后、制定综合治疗提供依据.结论 简化术式在争取根治性切除和消除病变遗漏、复发隐患的前提下,最大程度地减轻创伤,提高术后生活质量,更加符合功能性根治的原则,为综合治疗提供依据.
目的 探討分化型甲狀腺癌行簡化甲狀腺癌改良根治術的閤理性及I臨床應用價值.方法 自2007年1月至2010年6月在標準甲狀腺癌改良根治術基礎上簡化操作過程(簡稱簡化術式)治療分化型甲狀腺癌317例(349側).簡化術式採取頸根部低位弧形順皮紋小切口(約10～12 cm),分離上下皮瓣,但不在皮下遊離患側胸鎖乳突肌後緣及頸後三角皮下區域,可保護諸多通過這些區域穿齣的感覺神經.無論原髮竈大小、有無患側頸部淋巴結轉移的證據,均行甲狀腺患側葉+峽部+對側葉次全切除術,併在患側胸鎖乳突肌深麵清除主要轉移區域(Ⅱ a、Ⅲ、Ⅳ、Ⅴb區)的軟組織.不常規顯露副神經,以減輕對副神經的刺激.分組檢測各區淋巴結轉移率,比較不同術式術後併髮癥.結果簡化術式避免瞭傳統的"L"型或弧形長切口造成的明顯疤痕及頸部活動受限的弊耑;由于保留瞭全部肌肉及幾乎全部神經支配,明顯減輕或消除患側頸肩部活動障礙及痛、痳、脹等異常感覺;縮短手術時間;全麵瞭解頸部淋巴結狀態,可準確評價病變的臨床病理分期,為判斷預後、製定綜閤治療提供依據.結論 簡化術式在爭取根治性切除和消除病變遺漏、複髮隱患的前提下,最大程度地減輕創傷,提高術後生活質量,更加符閤功能性根治的原則,為綜閤治療提供依據.
목적 탐토분화형갑상선암행간화갑상선암개량근치술적합이성급I림상응용개치.방법 자2007년1월지2010년6월재표준갑상선암개량근치술기출상간화조작과정(간칭간화술식)치료분화형갑상선암317례(349측).간화술식채취경근부저위호형순피문소절구(약10～12 cm),분리상하피판,단불재피하유리환측흉쇄유돌기후연급경후삼각피하구역,가보호제다통과저사구역천출적감각신경.무론원발조대소、유무환측경부림파결전이적증거,균행갑상선환측협+협부+대측협차전절제술,병재환측흉쇄유돌기심면청제주요전이구역(Ⅱ a、Ⅲ、Ⅳ、Ⅴb구)적연조직.불상규현로부신경,이감경대부신경적자격.분조검측각구림파결전이솔,비교불동술식술후병발증.결과간화술식피면료전통적"L"형혹호형장절구조성적명현파흔급경부활동수한적폐단;유우보류료전부기육급궤호전부신경지배,명현감경혹소제환측경견부활동장애급통、마、창등이상감각;축단수술시간;전면료해경부림파결상태,가준학평개병변적림상병리분기,위판단예후、제정종합치료제공의거.결론 간화술식재쟁취근치성절제화소제병변유루、복발은환적전제하,최대정도지감경창상,제고술후생활질량,경가부합공능성근치적원칙,위종합치료제공의거.
Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.
