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
11期
918-921
,共4页
于文斌%宋韫韬%孙俊勇%张乃嵩
于文斌%宋韞韜%孫俊勇%張迺嵩
우문빈%송운도%손준용%장내숭
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%Neck dissection
目的 探讨临床淋巴结阳性(clinical node positive,cN+)的低危甲状腺乳头状癌患者传统改良性颈清扫术的改进方法.方法 回顾性分析2007-2010年期间收治的71例cN+低危甲状腺乳头状癌患者临床资料,其中男10例,女61例.T1 15例,T2 46例,T3 10例；均为临床Ⅰ期病例.其中26例患者触诊发现肿大淋巴结,45例患者触诊未发现而由超声检查发现肿大淋巴结.手术清扫淋巴结范围为Ⅱa、Ⅲ、Ⅳ区.结果 71例患者术后63例病理证实淋巴转移,转移率为88.7％,其中触诊发现肿大淋巴结的26例患者术后病理均发现转移淋巴结,转移率为100％；触诊未发现超声检查发现肿大淋巴结的45例患者术后病理证实37例有淋巴转移,转移率为82.2％.13例患者转移淋巴结累及1个淋巴结分区,31例累及2个分区,19例累及3个分区.患者随访24 ～ 60个月,中位随访时间42个月.术后颈部复发4例,复发率5.6％,2例Ⅴb区前份复发,2例颈动脉鞘区复发.结论 对于cN+低危甲状腺乳头状癌患者行Ⅱa、Ⅲ、Ⅳ区清扫是可接受的,可降低颈肩部并发症的发生率.
目的 探討臨床淋巴結暘性(clinical node positive,cN+)的低危甲狀腺乳頭狀癌患者傳統改良性頸清掃術的改進方法.方法 迴顧性分析2007-2010年期間收治的71例cN+低危甲狀腺乳頭狀癌患者臨床資料,其中男10例,女61例.T1 15例,T2 46例,T3 10例；均為臨床Ⅰ期病例.其中26例患者觸診髮現腫大淋巴結,45例患者觸診未髮現而由超聲檢查髮現腫大淋巴結.手術清掃淋巴結範圍為Ⅱa、Ⅲ、Ⅳ區.結果 71例患者術後63例病理證實淋巴轉移,轉移率為88.7％,其中觸診髮現腫大淋巴結的26例患者術後病理均髮現轉移淋巴結,轉移率為100％；觸診未髮現超聲檢查髮現腫大淋巴結的45例患者術後病理證實37例有淋巴轉移,轉移率為82.2％.13例患者轉移淋巴結纍及1箇淋巴結分區,31例纍及2箇分區,19例纍及3箇分區.患者隨訪24 ～ 60箇月,中位隨訪時間42箇月.術後頸部複髮4例,複髮率5.6％,2例Ⅴb區前份複髮,2例頸動脈鞘區複髮.結論 對于cN+低危甲狀腺乳頭狀癌患者行Ⅱa、Ⅲ、Ⅳ區清掃是可接受的,可降低頸肩部併髮癥的髮生率.
목적 탐토림상림파결양성(clinical node positive,cN+)적저위갑상선유두상암환자전통개량성경청소술적개진방법.방법 회고성분석2007-2010년기간수치적71례cN+저위갑상선유두상암환자림상자료,기중남10례,녀61례.T1 15례,T2 46례,T3 10례；균위림상Ⅰ기병례.기중26례환자촉진발현종대림파결,45례환자촉진미발현이유초성검사발현종대림파결.수술청소림파결범위위Ⅱa、Ⅲ、Ⅳ구.결과 71례환자술후63례병리증실림파전이,전이솔위88.7％,기중촉진발현종대림파결적26례환자술후병리균발현전이림파결,전이솔위100％；촉진미발현초성검사발현종대림파결적45례환자술후병리증실37례유림파전이,전이솔위82.2％.13례환자전이림파결루급1개림파결분구,31례루급2개분구,19례루급3개분구.환자수방24 ～ 60개월,중위수방시간42개월.술후경부복발4례,복발솔5.6％,2례Ⅴb구전빈복발,2례경동맥초구복발.결론 대우cN+저위갑상선유두상암환자행Ⅱa、Ⅲ、Ⅳ구청소시가접수적,가강저경견부병발증적발생솔.
Objective To explore the improvement of modified radical neck dissection in clinical node positive(cN +) low risk papillary thyroid cancer patients.Methods Seventy-one cases of papillary thyroid cancer with cN+ underwent selective neck dissection (Ⅱ a,Ⅲ,Ⅳ) from 2007 to 2010 were reviewed,including 10 men and 61 women.All patients were at stage Ⅰ,including 15 T1,46 T2,10 T3.Twenty-six patients were found Positive nodes were found by palpation in 26 cases and by ultrasonagraphy in 45 cases.Results Cervical lymph node metastasis were confirmed pathologically in 63 cases,with metastatic rate of 88.7％;100％ in cN + cases by palpation and 82.2％ in cN + cases by ultrasonagraphy,respectively.Metastatic nodes existed in one level in 13 cases,two levels in 31 cases,and three levels in 19cases.Recurrence occurred to 4 patients during follow up,with a recurrent rate of 5.6％,and 2 cases of them were found recurrence in the anterior part of Ⅴ b,2 cases in the carotid sheath.Conclusion Selective neck dissection (Ⅱ a,Ⅲ,Ⅳ) is acceptable for cN + low risk papillary thyroid cancer patients,which can decrease complications in neck and shoulder greatly.
