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目的探讨颈胸交界部转移性肿瘤的手术方法和疗效。方法回顾14例颈胸交界部转移性肿瘤的诊治经过。其中分化型甲状腺癌淋巴结转移11例(乳头状癌8例,滤泡癌3例),恶性嗜铬细胞瘤淋巴结转移1例,下咽和食管癌淋巴结转移各1例。手术步骤为离断胸锁关节后,掀起或部分切除同侧锁骨(必要时去除部分胸骨柄),解剖和保护喉返神经、膈神经及甲状腺下动脉,如肿瘤位于静脉深面,可切断和结扎颈内静脉和/或无名静脉后切除肿瘤。结果10例分化型淋巴结转移性甲状腺癌2～5年内无复发1例淋巴结转移性嗜铬细胞瘤2年内症状无复发淋巴结转移性下咽癌和食道癌患者均于末次术后11个月内死于肺和肝转移。无手术区局部复发和手术死亡者。结论分化型甲状腺癌等颈胸交界部淋巴结转移性肿瘤手术切除有效并相对安全。
Objective To investigate the surgical methods and efficacy of metastatic tumors at the junction of the neck and the thorax. Methods The diagnosis and treatment of metastatic tumors in 14 cases of cervical-thoracic junction were retrospectively reviewed. There were 11 cases of differentiated thyroid cancer with lymph node metastasis (papillary carcinoma in 8 cases, follicular carcinoma in 3 cases), malignant pheochromocytoma lymph node metastasis in 1 case, hypopharynx and esophageal cancer lymph node metastasis in 1 case. The surgical procedure is to disrupt the sternoclavicular joint, raise or partially remove the ipsilateral collarbone (remove some of the sternum if necessary), dissect and protect the recurrent laryngeal nerve, the phrenic nerve and the inferior thyroid artery. If the tumor is located deep in the vein, Tumors were excised after ligation of the internal jugular vein and / or anonymous vein. Results 10 cases of differentiated lymph node metastatic thyroid cancer without recurrence within 2 to 5 years in 1 case of lymph node metastatic pheochromocytoma within 2 years of no recurrence of symptoms of lymph node metastatic hypopharyngeal cancer and esophageal cancer patients died within 11 months after the last postoperative In lung and liver metastases. No surgical area of local recurrence and surgical death. Conclusion Differentiated thyroid cancer and other cervical lymph nodes metastasis of neck surgery effective and relatively safe.