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目的探讨分化型甲状腺癌选择性颈淋巴结清除术的手术指征、手术方法和结果。方法参照美国头颈外科协会颈淋巴结分区法和手术指南,前瞻性的对2004年1月至2006年6月的40例早中期(Ⅰ期35例,Ⅱ期2例,Ⅲ期3例)分化型甲状腺癌患者施行甲状腺切除加选择性颈淋巴结清除术(42例次)。对患者的手术指征、手术方法、并发症和术后颈淋巴结的病理结果进行分析。结果40例中,9例仅行中央组(Ⅵ组)清除;24例(57%)的清除范围≤3组,且均采用普通颈部横切口。总的淋巴结阳性率为67%(28/42)。其中,Ⅵ组阳性率为58%(23/40)、Ⅳ组为48%(16/33)、Ⅲ组为48%(14/29)、Ⅱ组为50%(7/14)、V组为27%(4/15)。Ⅵ组阳性率与Ⅳ、Ⅲ和Ⅱ组相比差异无统计学意义(P>0.05)。20%(8/40)的标本中找到1枚误切的甲状旁腺;27%(11/40)的患者有一过性低钙表现,无永久性者;7.5%(3/40)有短暂性喉返神经麻痹,无永久性者。19例随访时间超过6个月者,6个月时颈部超声未见肿大淋巴结。结论选择性颈淋巴结清除术对早中期分化型甲状腺癌患者实施是合理的。
Objective To investigate the surgical indications, surgical methods and results of selective cervical lymph node dissection for differentiated thyroid cancer. Methods According to the American Society of Head and Neck Surgery cervical lymph node zoning method and surgical guidelines, prospectively from January 2004 to June 2006 40 cases of early and mid-term (35 cases of stage Ⅰ, 2 cases of stage Ⅱ, Ⅲ stage Ⅲ) Thyroid cancer patients underwent thyroidectomy plus selective cervical lymph node dissection (42 cases). The patient’s surgical indications, surgical methods, complications and postoperative pathological findings of cervical lymph nodes were analyzed. Results Among the 40 cases, 9 cases were removed only in the central group (Ⅵ), 24 cases (57%) were removed in 3 cases, and the common cervical transverse incisions were used. The overall positive rate of lymph nodes was 67% (28/42). Among them, the positive rate was 58% (23/40) in group VI, 48% (16/33) in group IV, 48% (14/29) in group III, 50% (7/14) in group II, 27% (4/15). There was no significant difference in the positive rate of Ⅵ between groups Ⅳ, Ⅲ and Ⅱ (P> 0.05). One misdiagnosed parathyroid was found in 20% (8/40) of the specimens; 27% (11/40) of the patients had transient hypocalcemia and were not permanent; 7.5% (3/40) had a transient Recurrent laryngeal nerve paralysis, no permanent. Nineteen patients were followed up for more than 6 months. Six months later, no neck lymph node enlargement was found. Conclusions Selective cervical lymph node dissection is feasible for patients with early-stage differentiation of thyroid cancer.