中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2012年
10期
823-826
,共4页
甲状腺肿瘤%癌,乳头状%颈淋巴结清扫术
甲狀腺腫瘤%癌,乳頭狀%頸淋巴結清掃術
갑상선종류%암,유두상%경림파결청소술
Thyroid neoplasms%Carcinoma,papillary%Radical neck dissection
目的 探讨甲状腺乳头状癌中央区淋巴结可疑残留的补救治疗策略.方法 回顾性分析2006年1月至2009年1月行补救性中央区淋巴清扫术且临床随访资料完整的甲状腺乳头状癌患者85例.结果 补救性中央区淋巴清扫术后59例患者有阳性淋巴结,总的淋巴转移率为69.4％(59/85).59例共清扫336枚淋巴结,平均5.7枚；共有159枚转移淋巴结,每例平均2.7枚.外院记录已行清扫的6例患者补救手术后4例病理结果有淋巴转移,其中2例残留淋巴结位于头臂动脉与气管相交处,1例位于喉返神经的深面,1例位于气管前胸腺内.本组并发症发生率为10.6％(9/85),其中5例出现声嘶,其中2例患者发生暂时性甲状旁腺功能低下,术后出血1例,颈阔肌皮瓣下积液1例.随访3～5年,随访中位时间44个月,对侧中央区复发1例,侧颈复发4例,1例患者出现肺转移,全组无死亡病例.结论 对于未行中央区淋巴清扫但转移风险高(T3、T4级,原发灶被膜外侵犯,原发灶考虑肿瘤残留,血管或淋巴管侵犯)或在影像学下发现可疑转移淋巴结的病例,以及对于已行中央区清扫但考虑清扫范围不足、残留可能性大,或者未行中央区清扫,但术后病理发现阳性淋巴结的病例,须行补救中央区清扫手术.
目的 探討甲狀腺乳頭狀癌中央區淋巴結可疑殘留的補救治療策略.方法 迴顧性分析2006年1月至2009年1月行補救性中央區淋巴清掃術且臨床隨訪資料完整的甲狀腺乳頭狀癌患者85例.結果 補救性中央區淋巴清掃術後59例患者有暘性淋巴結,總的淋巴轉移率為69.4％(59/85).59例共清掃336枚淋巴結,平均5.7枚；共有159枚轉移淋巴結,每例平均2.7枚.外院記錄已行清掃的6例患者補救手術後4例病理結果有淋巴轉移,其中2例殘留淋巴結位于頭臂動脈與氣管相交處,1例位于喉返神經的深麵,1例位于氣管前胸腺內.本組併髮癥髮生率為10.6％(9/85),其中5例齣現聲嘶,其中2例患者髮生暫時性甲狀徬腺功能低下,術後齣血1例,頸闊肌皮瓣下積液1例.隨訪3～5年,隨訪中位時間44箇月,對側中央區複髮1例,側頸複髮4例,1例患者齣現肺轉移,全組無死亡病例.結論 對于未行中央區淋巴清掃但轉移風險高(T3、T4級,原髮竈被膜外侵犯,原髮竈攷慮腫瘤殘留,血管或淋巴管侵犯)或在影像學下髮現可疑轉移淋巴結的病例,以及對于已行中央區清掃但攷慮清掃範圍不足、殘留可能性大,或者未行中央區清掃,但術後病理髮現暘性淋巴結的病例,鬚行補救中央區清掃手術.
목적 탐토갑상선유두상암중앙구림파결가의잔류적보구치료책략.방법 회고성분석2006년1월지2009년1월행보구성중앙구림파청소술차림상수방자료완정적갑상선유두상암환자85례.결과 보구성중앙구림파청소술후59례환자유양성림파결,총적림파전이솔위69.4％(59/85).59례공청소336매림파결,평균5.7매；공유159매전이림파결,매례평균2.7매.외원기록이행청소적6례환자보구수술후4례병리결과유림파전이,기중2례잔류림파결위우두비동맥여기관상교처,1례위우후반신경적심면,1례위우기관전흉선내.본조병발증발생솔위10.6％(9/85),기중5례출현성시,기중2례환자발생잠시성갑상방선공능저하,술후출혈1례,경활기피판하적액1례.수방3～5년,수방중위시간44개월,대측중앙구복발1례,측경복발4례,1례환자출현폐전이,전조무사망병례.결론 대우미행중앙구림파청소단전이풍험고(T3、T4급,원발조피막외침범,원발조고필종류잔류,혈관혹림파관침범)혹재영상학하발현가의전이림파결적병례,이급대우이행중앙구청소단고필청소범위불족、잔류가능성대,혹자미행중앙구청소,단술후병리발현양성림파결적병례,수행보구중앙구청소수술.
Objective To evaluate the salvage central neck dissection (CND) for papillary thyroid cancer in the patients with suspicious residual positive lymph nodes in the central compartment.Methods A total of 85 cases undergoing salvage CND between January 2006 to Janurary 2009 was reviewed.Results Fifty-nine (69.4％) of the 85 patients showed residual positive lymph nodes in the central compartments.The number of dissected lymph nodes for each dissection ranged 2 - 13 nodes,with an average of 5.7 nodes.A total of 159 positive lymph nodes were found in the 59 cases,with an average of 2.7 positive nodes in each case.Four of 6 patients who underwent initial CND in other hospitals were found with residual positive nodes in the central apartments.The incidence of postoperative complications for the salvage CND was 10.6％(9/85),of them 5 cases with hoarsness,2 cases with transient hypoparathyroidism, 1 case with postoperative bleeding,and 1 case with subplatysmal effusion. The median of follow-up after salvage CND was 44 months (3-5 years),showing contralateral central recurrence in 1 case,lateral neck recurrence in 4 cases,lung metastasis in 1 case,and no death case.Conclusions Salvage CND should be done for those patients without undergoing initial CND but with positive nodes found after thyroidectomy or the high risks ( T3,T4,extrathyroid extension,residual in primary site,and vascular or lymphatic vessel invasion) ; and also for those patients with initial CND but insufficient extent.
