CAJ | 학술논문

目的探讨内镜辅助下颈部小切口颈清扫术的安全性和治疗效果.方法自2010年3月至2011年5月间采用内镜辅助下小切口颈清扫术治疗甲状腺乳头状癌颈部淋巴结转移患者18例,其中男性4例,女性14例,年龄28 ～56岁.术前超声明确提示甲状腺肿瘤为恶性.所有手术均在全麻下进行内镜辅助下甲状腺切除和颈清扫术,其中Ⅱ～Ⅳ、Ⅵ区清扫6例,Ⅱ～Ⅵ区清扫12例.过程与常规手术相同.结果本组患者切口长度均为5 cm,术后病理示T1 5例,T25例,T36例,T42例.N0 5例,N1a0例,N1b 13例.本组内镜辅助手术时间为2.5～5.0h,平均3.6h.术后未发生严重并发症.平均术后伤口引流量为168 ml,平均术后拔出引流管时间为4.6d,平均清扫颈部淋巴结33.1枚.所有患者经过2～3年随访未出现甲状腺局部和颈部淋巴结复发.结论颈部小切口在内镜辅助下完成侧颈部淋巴结Ⅱ～Ⅵ区清扫术安全、可靠,手术清扫彻底,术后美容效果满意.
목적 탐토내경보조하경부소절구경청소술적안전성화치료효과.방법 자2010년3월지2011년5월간채용내경보조하소절구경청소술치료갑상선유두상암경부림파결전이환자18례,기중남성4례,녀성14례,년령28 ～56세.술전초성명학제시갑상선종류위악성.소유수술균재전마하진행내경보조하갑상선절제화경청소술,기중Ⅱ～Ⅳ、Ⅵ구청소6례,Ⅱ～Ⅵ구청소12례.과정여상규수술상동.결과 본조환자절구장도균위5 cm,술후병리시T1 5례,T25례,T36례,T42례.N0 5례,N1a0례,N1b 13례.본조내경보조수술시간위2.5～5.0h,평균3.6h.술후미발생엄중병발증.평균술후상구인류량위168 ml,평균술후발출인류관시간위4.6d,평균청소경부림파결33.1매.소유환자경과2～3년수방미출현갑상선국부화경부림파결복발.결론 경부소절구재내경보조하완성측경부림파결Ⅱ～Ⅵ구청소술안전、가고,수술청소철저,술후미용효과만의.
Objective Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar.It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.Methods Between March 2010 and May 2011,6 cases of PTC with no definite lymph node metastasis at level Ⅱ-Ⅳ and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level Ⅱ-Ⅳ received minimally invasive endoscopy-assisted lateral neck dissection.After accomplishing thyroidectomy and central compartment dissection,ipsilateral level Ⅱ-Ⅳ,Ⅵ or Ⅱ-Ⅵ dissection via small neck incision was performed.Results This procedure was carried out successfully in all 18 patients.The incision was 5 cm every patient.Postoperative pT1 was 5 cases,pT2 5 cases,pT3 6 cases,pT4 2 cases,pN0 5 cases,N1b 13 cases.Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours).No significant blood loss or complications occurred.Thirteen patients showed lymph node metastases in both central or lateral neck.The mean number of harvested nodes was 33.1 (ranging 16-61).No residual or recurrent disease was found in 2-3 years follow-up time.Conclusion Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.