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目的:探讨一种改良保留颈丛的领式切口功能性颈淋巴结清扫术治疗甲状腺乳头状癌。方法:2012年1月至2013年12月95例甲状腺乳头状癌病人在解放军第八五医院普外科行改良保留颈丛的功能性颈淋巴结清扫术。结果:95例完整清扫Ⅱ、Ⅲ、Ⅳ、Ⅴ区淋巴结。保留锁骨上神经的中间及向内的分支等重要颈部结构。Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴa和Ⅴb区淋巴结转移率分别为34.7%、12.6%、55.8%、82.1%、4.2%和14.7%。病人术后外耳、肩部、、锁骨下和颈外侧感觉均存在。结论:该改良术式既能完整清扫与甲状腺乳头状癌有关的颈侧区淋巴结,又保留颈丛神经的大多数感觉功能,可作为替代择区性颈淋巴结清扫术的一种选择。
Objective: To explore a modified neck-retained neck incision functional neck lymph node dissection for the treatment of papillary thyroid carcinoma. METHODS: From January 2012 to December 2013, 95 patients with papillary thyroid carcinoma underwent functional cervical lymph node dissection in the general surgery department of the 85th People’s Liberation Army General Hospital. Results: 95 cases of complete dissection Ⅱ, Ⅲ, Ⅳ, Ⅴ lymph nodes. Maintain the middle of the supraclavicular nerve and inward branches and other important neck structure. The rates of lymph node metastasis in group Ⅱa, Ⅱb, Ⅲ, Ⅳ, Va and Ⅴb were 34.7%, 12.6%, 55.8%, 82.1%, 4.2% and 14.7%, respectively. Patients after the operation of the external ear, shoulder, subclavian and neck outside the presence of both. Conclusion: The modified operation can not only completely clear the cervical lymph nodes associated with papillary thyroid carcinoma, but also retain most of the sensory functions of the cervical plexus, which can be used as an alternative to selective cervical lymph node dissection.