中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
1期
24-27
,共4页
甲状腺肿瘤%淋巴转移%颈淋巴结清扫术
甲狀腺腫瘤%淋巴轉移%頸淋巴結清掃術
갑상선종류%림파전이%경림파결청소술
Thyroid neoplasms%Lymphatic metastasis%Neck dissection
目的 探讨甲状腺乳头状癌患者颈部残留转移淋巴结挽救治疗策略.方法 回顾性分析2006年9月-2010年6月收治的行挽救性颈淋巴结清扫术且有完整随访的97例甲状腺乳头状癌患者的临床资料.结果 97例患者中80例侧后颈部淋巴结有癌残留,总的转移淋巴结残留率82.47％,首次行侧后颈清扫的56例中,残留率85.71％,其中行淋巴结摘除的8例均有癌残留,残留率100％;部分侧后颈清扫的30例,残留率93.33％;一侧全侧后颈清扫的18例中,残留率66.67％.未行侧后颈清扫的41例中,残留率78.05％.每例清扫的淋巴结数目在15 ～45个,平均每例23个,平均每例有转移淋巴结8.21个.97例患者中67例有Ⅵ区淋巴结残留,残留率为69.07％,行Ⅵ区清扫的13例患者,7例有淋巴结残留,残留率53.85％；未行清扫的84例中,67例有淋巴结转移,残留率71.42％,Ⅵ区残留部位主要在头臂动脉与气管相交处和喉返神经的深面. 结论 提高术前影像学诊断能力可减少甲状腺乳头状癌患者颈部淋巴结残留；选择正确的清扫术式和足够大的手术范围是挽救手术的关键.
目的 探討甲狀腺乳頭狀癌患者頸部殘留轉移淋巴結輓救治療策略.方法 迴顧性分析2006年9月-2010年6月收治的行輓救性頸淋巴結清掃術且有完整隨訪的97例甲狀腺乳頭狀癌患者的臨床資料.結果 97例患者中80例側後頸部淋巴結有癌殘留,總的轉移淋巴結殘留率82.47％,首次行側後頸清掃的56例中,殘留率85.71％,其中行淋巴結摘除的8例均有癌殘留,殘留率100％;部分側後頸清掃的30例,殘留率93.33％;一側全側後頸清掃的18例中,殘留率66.67％.未行側後頸清掃的41例中,殘留率78.05％.每例清掃的淋巴結數目在15 ～45箇,平均每例23箇,平均每例有轉移淋巴結8.21箇.97例患者中67例有Ⅵ區淋巴結殘留,殘留率為69.07％,行Ⅵ區清掃的13例患者,7例有淋巴結殘留,殘留率53.85％；未行清掃的84例中,67例有淋巴結轉移,殘留率71.42％,Ⅵ區殘留部位主要在頭臂動脈與氣管相交處和喉返神經的深麵. 結論 提高術前影像學診斷能力可減少甲狀腺乳頭狀癌患者頸部淋巴結殘留；選擇正確的清掃術式和足夠大的手術範圍是輓救手術的關鍵.
목적 탐토갑상선유두상암환자경부잔류전이림파결만구치료책략.방법 회고성분석2006년9월-2010년6월수치적행만구성경림파결청소술차유완정수방적97례갑상선유두상암환자적림상자료.결과 97례환자중80례측후경부림파결유암잔류,총적전이림파결잔류솔82.47％,수차행측후경청소적56례중,잔류솔85.71％,기중행림파결적제적8례균유암잔류,잔류솔100％;부분측후경청소적30례,잔류솔93.33％;일측전측후경청소적18례중,잔류솔66.67％.미행측후경청소적41례중,잔류솔78.05％.매례청소적림파결수목재15 ～45개,평균매례23개,평균매례유전이림파결8.21개.97례환자중67례유Ⅵ구림파결잔류,잔류솔위69.07％,행Ⅵ구청소적13례환자,7례유림파결잔류,잔류솔53.85％；미행청소적84례중,67례유림파결전이,잔류솔71.42％,Ⅵ구잔류부위주요재두비동맥여기관상교처화후반신경적심면. 결론 제고술전영상학진단능력가감소갑상선유두상암환자경부림파결잔류；선택정학적청소술식화족구대적수술범위시만구수술적관건.
Objective To evaluate the salvage surgery for papillary thyroid cancer patients with residual neck metastatic lymph nodes after thyroidectomy.Methods Clinical data of 97 patients undergoing salvage neck dissection between September 2007 to June 2010 were analyzed retrospectively.Results Among 97 patients,residual metastatic lymph nodes were found in 80 patients in lateroposterial neck,overall residual rate was 82.47％.Residual rate was 85.71％ in 56 patients who underwent initial lateroposterial neck dissection in other hospitals:100％ in 8 patients who underwent berry-picking; 93.33％ in 30 patients who underwent partial dissection; 66.67％ in 18 patients who underwent whole neck dissection.Residual rate was 78.05％ in 41 patients who did not undergo initial lateroposterial neck dissection.The number of dissected lymph nodes was 15-45,with an average of 23 nodes removed and 8.21 metastatic lymph nodes per case.Residual metastatic lymph nodes were found in 67 patients in central neck,overall residual rate was 82.47％,residual rate was 53.85％ in 13 patients who underwent initial central neck dissection,and 71.42％ in 84 patients who did not undergo initial central neck dissection.Conclusions Correct imaging diagnosis decreases cervical residual metastatic lymph nodes in patients with papillary thyroid cancer.Successful salvage operation lies in choosing correct mode of neck dissection and carrying out sufficient dissection.
