【作者】 陈健； 胡少南； 邓万凯； 王亚秋； 何家林；

【Author】 CHEN Jian,HU Shao-nan,DENG Wan-kai,WANG Ya-qiu,HE Jia-lin Department of head and neck surgery,Hubei cancer hospital,Wuhan 430079,China

【机构】 湖北省肿瘤医院头颈外科；

【摘要】 目的分化型甲状腺癌好发于中青年女性,预后良好,甲状腺癌根治术是常规的治疗方法。常用的单臂弧形切口、宽蒂矩形切口和平行双横切口等虽能充分暴露术野,满足手术需要,但影响术后美观。为此探讨低位长领式切口在分化型甲状腺癌根治术中的可行性和效果。方法术中行快速冰冻切片证实为甲状腺乳头状癌或滤泡状癌。采用低位长领式切口,位于胸骨上窝1.0～2.0cm,沿皮纹走向切开,自健侧胸锁乳突肌中间至患侧胸锁乳突肌外缘与斜方肌前缘之间(单侧癌),或达双侧胸锁乳突肌外缘与斜方肌前缘之间(双侧癌)。回顾性分析57例患者低位长领式切口在甲状腺癌根治术中的可行性和效果。结果其中24例行功能性颈淋巴结清除术(Ⅱ～Ⅵ区),33例行择区性颈淋巴结清除术(至少含Ⅲ、Ⅳ、Ⅵ区),无手术死亡病例,淋巴瘘或乳糜瘘5例,无皮瓣坏死、永久性声嘶、耸肩困难等。术后2例患者疤痕明显,余切口愈合良好。随访52例,随访时间6个月～11年,均行甲状腺素内分泌治疗。对侧癌4例,颈部淋巴结再发转移7例,均再行甲状腺癌根治术;肺转移1例,行放射性碘治疗,存活至今;死亡3例,原因分别为脑卒中、车祸和肾功能衰竭。结论低位长领式切口较为隐蔽、美观,局部暴露和颈淋巴结清扫满意,能满足分化型甲状腺癌根治术要求,是甲状腺癌根治性手术较为理想的切口选择。更多还原

【Abstract】 Objective Differentiated thyroid cancer(DTC) is prone to occur in the young and middle-aged women with generally good prognosis.The routine treatment contains radical operation of thyroid cancer.The commonly used incisions such as hockey stick incision are enough to expose the surgical field,while they were not good for appearance.This article is to explore the feasibility and effectiveness of application of extended low collar incision in radical operation of DTC.Methods All patients were confirmed to be papillary or follicular carcinoma by rapid frozen section during the operation.All were managed by extended low collar incision which located 1.0～2.0cm above suprasternal fossa,dissected along dermatoglyph and between the middle of unaffected sternocleidomastoid muscle and a point among the exterior margin of sternocleidomastoid muscle and anterior border of trapezius(unilateral cancer) or between bilateral points among the exterior margin of sternocleidomastoid muscle and anterior border of trapezius(bilateral cancer). We will retrospectively analyze the feasibility and effectiveness of application of extended low collar incision in radical operation of DTC of 57 patients.Results 24 patients experienced functional neck dissection(Ⅱ～Ⅵregion) while 33 patients selective neck dissection(at leastⅢ,ⅣandⅥregion).No patients were dead during Peroperative Period;5 patients suffered lymphatic fistula or chylous fistula; No patients suffered necrosis of skin flap,permanent hoarseness,difficulty of shrug,et al.2 patients remained apparent scar.Follow up of 52 cases with period from 6 months to 11 years.All received postoperative thyroid hormone suppression treatment.4 patients recurred contralateral thyroid cancer and 7 patients lymph nodes metastasis;All experienced radical operation again.1 patients with pulmonary metastasis received radioiodine ablation treatment and was still alive.3 patients were dead and causes of death were stroke,road accident,and renal failure respectively.Conclusion Extended low collar incision is fairly covert,specious, good enough for exposure of surgical field and can meet the demands of radical operation of DTC which is an ideal incision for DTC.更多还原