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
2013年
9期
708-711
,共4页
甲状腺肿瘤%淋巴转移%腋%纵隔%淋巴结切除术
甲狀腺腫瘤%淋巴轉移%腋%縱隔%淋巴結切除術
갑상선종류%림파전이%액%종격%림파결절제술
Thyroid neoplasms%Lymphatic metastasis%Axillas%Mediastium%Lymph node excision
目的 探讨甲状腺癌上纵隔和腋窝淋巴结转移的临床特点及手术疗效.方法 回顾性分析2006年5月至2011年5月6例经病理证实的伴上纵隔及腋窝淋巴结转移甲状腺癌的诊治经过,其中甲状腺乳头状癌5例,滤泡状癌1例；首次治疗1例,外院1次术后复发2例(其中1例接受放射治疗60 Cy),外院2次术后复发3例.采用甲状腺全切或残体切除术+颈部、上纵隔及腋窝淋巴清扫术+ 131I治疗+左旋甲状腺素抑制治疗.结果 腋窝淋巴结转移者分别为2/7、3/12、2/6、1/5、3/7及3/10.上纵隔转移淋巴结数目2～6枚,平均4.3枚,伴咽后间隙淋巴结转移1例(1/1).术后暂时性低钙血症2例,乳糜漏1例,霍纳综合征3例,无新发喉返神经麻痹,无锁骨下动静脉或腋动静脉损伤,无上肢水肿、感觉或运动障碍者,无肺气肿或纵隔气肿者.术后分别随诊23、37、43、49、54及77个月,颈部淋巴结复发(同侧Ⅴ区)和新发肺转移各1例,术前肺转移者转移灶较前无增大.上纵隔及腋窝未见复发或骨转移者.1例术后4年死于心脏病,其余均存活.结论 发生上纵隔及腋窝淋巴结转移的分化型甲状腺癌仍有较好治疗效果,也相对安全.
目的 探討甲狀腺癌上縱隔和腋窩淋巴結轉移的臨床特點及手術療效.方法 迴顧性分析2006年5月至2011年5月6例經病理證實的伴上縱隔及腋窩淋巴結轉移甲狀腺癌的診治經過,其中甲狀腺乳頭狀癌5例,濾泡狀癌1例；首次治療1例,外院1次術後複髮2例(其中1例接受放射治療60 Cy),外院2次術後複髮3例.採用甲狀腺全切或殘體切除術+頸部、上縱隔及腋窩淋巴清掃術+ 131I治療+左鏇甲狀腺素抑製治療.結果 腋窩淋巴結轉移者分彆為2/7、3/12、2/6、1/5、3/7及3/10.上縱隔轉移淋巴結數目2～6枚,平均4.3枚,伴嚥後間隙淋巴結轉移1例(1/1).術後暫時性低鈣血癥2例,乳糜漏1例,霍納綜閤徵3例,無新髮喉返神經痳痺,無鎖骨下動靜脈或腋動靜脈損傷,無上肢水腫、感覺或運動障礙者,無肺氣腫或縱隔氣腫者.術後分彆隨診23、37、43、49、54及77箇月,頸部淋巴結複髮(同側Ⅴ區)和新髮肺轉移各1例,術前肺轉移者轉移竈較前無增大.上縱隔及腋窩未見複髮或骨轉移者.1例術後4年死于心髒病,其餘均存活.結論 髮生上縱隔及腋窩淋巴結轉移的分化型甲狀腺癌仍有較好治療效果,也相對安全.
목적 탐토갑상선암상종격화액와림파결전이적림상특점급수술료효.방법 회고성분석2006년5월지2011년5월6례경병리증실적반상종격급액와림파결전이갑상선암적진치경과,기중갑상선유두상암5례,려포상암1례；수차치료1례,외원1차술후복발2례(기중1례접수방사치료60 Cy),외원2차술후복발3례.채용갑상선전절혹잔체절제술+경부、상종격급액와림파청소술+ 131I치료+좌선갑상선소억제치료.결과 액와림파결전이자분별위2/7、3/12、2/6、1/5、3/7급3/10.상종격전이림파결수목2～6매,평균4.3매,반인후간극림파결전이1례(1/1).술후잠시성저개혈증2례,유미루1례,곽납종합정3례,무신발후반신경마비,무쇄골하동정맥혹액동정맥손상,무상지수종、감각혹운동장애자,무폐기종혹종격기종자.술후분별수진23、37、43、49、54급77개월,경부림파결복발(동측Ⅴ구)화신발폐전이각1례,술전폐전이자전이조교전무증대.상종격급액와미견복발혹골전이자.1례술후4년사우심장병,기여균존활.결론 발생상종격급액와림파결전이적분화형갑상선암잉유교호치료효과,야상대안전.
Objective To investigate the clinical characteristics and management of thyroid carcinoma with the upper mediastinal and axillary metastasis.Methods Six cases of thyroid carcinomas with metastases to mediastinum and axillary,in addition to the neck,undergoing surgeries from 2006 to 2011 were reviewed.Five cases was papillary carcinoma and one was follicular carcinoma.Of six patients,five underwent surgical treatment at least one time previously and one of them received a radiotherapy with total dose of 60 Gy.131Ⅰ treatment and thyroxine were used postoperatively in all cases.Results The numbers of metastatic nodes in the axillary were 2/7,3/12,2/6,1/5,3/7 and 3/10 respectively,while the numbers in the upper mediastinum ranged from 2 to 6,with a 4.3 average,a metastatic lymph node in the retropharyngeal space was also found in one patient.Horner's sign occurred in three cases,temporary hypocalcemia in two cases and chylous fistula in one case.No injury to the recurrent laryngeal nerve or to important vessels.Neck or lower mediastinum recurrence and new lung metastasis occurred in three cases separately.No recurrence in the upper mediastinum or axillary area was found with the follow-up of 23-77 months.One died of heart disease 4 years after operation.Conclusion The surgical treatment of node metastases in the upper mediastinum and axillary from the well-differentiated thyroid cancer is safe and has a promising outcome.
