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目的探讨简化的功能性颈部淋巴结清除术治疗高危甲状腺乳头状癌的临床效果。方法对1994年2月~2013年5月收治的高危甲状腺乳头状癌患者80例手术治疗的临床资料进行回顾性分析,其中1994年2月~2011年10月施行功能性颈部淋巴结清扫术50例为FND组,2011年11月~2013年5月施行简化的功能性颈部淋巴结清除术30例为SFND组。术后坚持终生服用甲状腺素片,伴有腺体外浸润的6例给予131I内照射治疗。结果施行患侧腺叶全切除+峡部切除+对侧次全切除术71例,双侧甲状腺全切除9例。手术近期并发症共8例(10%),其中声音嘶哑、乳糜漏、症状性低钙血症发生率,FND组分别为4.0%(2/50)、4.0%(2/50)和2.0%(1/50),SFND组均为3.3%(1/30),两组比较差异无统计学意义(P>0.05)。以3个月~1年为随访期限记录手术远期并发症,FND组与SFND组患侧颈、肩及上肢感觉异常发生率分别为16.0%(8/50)和0,活动障碍发生率分别为14.0%(7/50)和0,两组比较差异有统计学意义(P<0.05)。结论规范的手术治疗是改善甲状腺乳头状癌患者预后的关键因素,SFND用于高危甲状腺乳头状癌的治疗,有助于保护患侧颈、肩及上肢感觉和运动功能,减少癌复发和转移。
Objective To investigate the clinical effect of simplified functional neck lymph node dissection in the treatment of high-risk thyroid papillary carcinoma. Methods The clinical data of 80 cases of high-risk thyroid papillary carcinoma treated from February 1994 to May 2013 were retrospectively analyzed. Among them, functional neck lymph node dissection was performed from February 1994 to October 2011 Cases for the FND group, November 2011 ~ May 2013 implementation of simplified functional neck lymph node dissection in 30 cases of SFND group. Postoperative maintenance of thyroid hormone tablets, 6 cases with infiltration of the gland give 131I irradiation. Results The implementation of total ileus lobectomy + isthmic resection + contralateral subtotal resection in 71 cases, bilateral thyroidectomy in 9 cases. There were 8 cases (10%) of the recent complications of surgery, including hoarseness, chylous leakage, the incidence of symptomatic hypocalcemia, 4.0% (2/50), 4.0% (2/50) and 2.0% (1/50) in the SFND group and 3.3% (1/30) in the SFND group, respectively. There was no significant difference between the two groups (P> 0.05). The long-term complications of surgery were recorded from 3 months to 1 year follow-up. The incidence of sensory abnormalities in the neck, shoulder and upper limbs of the FND group and the SFND group were 16.0% (8/50) and 0 respectively, and the incidences of movement disorders 14.0% (7/50) and 0, the difference between the two groups was statistically significant (P <0.05). Conclusion Standardized surgical treatment is a key factor to improve the prognosis of thyroid papillary carcinoma. SFND is used to treat papillary thyroid carcinoma at high risk, which helps to protect the sensory and motor functions of the affected neck, shoulder and upper limbs and reduce the recurrence and metastasis of cancer.