CAJ | 학술논문

目的：探索更加美观隐蔽的甲状腺癌颈清扫术手术切口。方法将2009年1月～2012年12月在我院接受颈清扫术的72例甲状腺癌颈淋巴结转移患者采用改良L型切口进行手术。其中22例患者行甲状腺全切术+患侧Ⅰ～Ⅵ区颈清扫术；另50例患者单纯行颈清扫术，清扫范围主要为Ⅰ～Ⅴ区淋巴结。颈清扫切口行于斜方肌表面发际前缘自乳突尖后向下行至锁骨上约1.5cm处循皮纹横行向前至颈前中部或与原甲状腺手术切口相连。其中根治性颈清扫术4例，功能性颈清扫术68例。结果72例患者共行83侧颈清扫术，均行改良L型切口。手术过程均顺利，术野暴露满意，手术时间为128～196min，平均145.3±23.8min。共11例患者出现术后并发症，其中颈部积液6例、副神经损伤3例、乳糜漏2例。无皮瓣坏死、切口感染等并发症发生。术后患者颈部切口瘢痕隐蔽，外观影响小。术后随访6个月～4年，淋巴结复发率为0.0%。结论采用改良L型切口行颈清扫术暴露满意，手术并发症少，术后切口隐蔽，是甲状腺癌颈清扫术一种较为理想的手术入路。
목적：탐색경가미관은폐적갑상선암경청소술수술절구。방법장2009년1월～2012년12월재아원접수경청소술적72례갑상선암경림파결전이환자채용개량L형절구진행수술。기중22례환자행갑상선전절술+환측Ⅰ～Ⅵ구경청소술；령50례환자단순행경청소술，청소범위주요위Ⅰ～Ⅴ구림파결。경청소절구행우사방기표면발제전연자유돌첨후향하행지쇄골상약1.5cm처순피문횡행향전지경전중부혹여원갑상선수술절구상련。기중근치성경청소술4례，공능성경청소술68례。결과72례환자공행83측경청소술，균행개량L형절구。수술과정균순리，술야폭로만의，수술시간위128～196min，평균145.3±23.8min。공11례환자출현술후병발증，기중경부적액6례、부신경손상3례、유미루2례。무피판배사、절구감염등병발증발생。술후환자경부절구반흔은폐，외관영향소。술후수방6개월～4년，림파결복발솔위0.0%。결론채용개량L형절구행경청소술폭로만의，수술병발증소，술후절구은폐，시갑상선암경청소술일충교위이상적수술입로。
Objective To explore a cosmetic and secluded incision in the neck dissection for thyroid cancer. Methods The modified L shape incision was used for neck dissection in 72 patients with cervical lymph nodes metastases of thyroid carcinoma from January 2009 to December 2012 in our hospital. Among the 72 patients , 22 underwent simultaneous the total thyroidectomy and the affected side neck dissection;whereas the other 50 patients, who suffered from cervical lymph node metastases after thyroidectomy, were treated with affected side neck dissection alone. The longitudinal portion of the incision runs from the mastoid process downward, along the surface of the trapezius muscle and hairline border, then curves gently at approximately 1.5 cm above the clavicle. The transverse component follows the natural cervical crease and extended to the middle of the neck or the thyroidectomy scar. The neck dissection mainly involves level Ⅰ to Ⅴ lymph node groups. Eighty-three procedures of neck dissection were performed in 72 patients, including 4 radical neck dissection and 68 functional neck dissection. Results We employed modified L shape incision in the 72 patients who underwent neck dissection. It was successful during the surgery;meanwhile,the incision permits ideal exposure of the operative field.The operation time was 128-196 min,and the mean time was 145.3±23.8 min.Eleven patients developed complications related to neck dissection, including 6 cases of neck effusion, 3 spinal accessory nerve injury and 2 chylous leakage. No skin flap necrosis, incision infection or any other complications occured. All patients had a satisfactory postoperative appearance, secluded and cosmetic incisions. The follow-up period in these patients were 6 months to 4 years, no cervical recurrence was identified in any case. Conclusion With ideal exposure of surgical field, low operation complications and a cosmetic and secluded incision scar, the modified L shape incision is an ideal approach to the neck dissection for thyroid cancer.