腔镜辅助改良Miccoli术式在甲状腺癌颈侧区淋巴结清扫中的应用体会
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摘要
目的:探讨腔镜辅助改良Miccoli术式在甲状腺癌颈侧区淋巴结清扫中的安全性及美容优势。方法:为25例甲状腺乳头状癌患者行腔镜辅助下Ⅱ、Ⅲ、Ⅳ、Ⅴ区颈侧淋巴结清扫术。术中应用自制拉钩建腔。手术路径不同于传统的颈清,在颈深筋膜浅层与深层(椎前筋膜)之间的颈深筋膜中层(颈内脏筋膜)操作。结果:25例手术均获成功,效果满意。颈部切口4～5 cm,手术时间平均(183.60±25.92)min,清扫Ⅱ、Ⅲ～Ⅳ、Ⅴ区淋巴结平均(5.64±3.53)、(9.00±3.48)、(6.68±5.00)枚,住院费用平均(15 929.53±4 126.43)元。术后发生乳糜瘘4例,面部水肿2例。结论:腔镜辅助改良Miccoli术式微创、安全、美容效果优势明显,清扫层次不同于传统术式,值得进一步探索。
Objective:To study the safety and cosmetic advantage of endoscopic-assisted improved Miccoli lateral neck dissection for thyroid carcinoma.Methods:Twenty-five patients who suffered from papillary thyroid carcinoma underwent endoscopic-assisted lateral neck dissection of Ⅱ,Ⅲ,Ⅳ,Ⅴ region.Self-made retractors were used to build a cavity during surgery.Different from the traditional operation,this operation was working between superficial and deep layer of deep cervical fascia(prevertebral fascia),which was the middle layer of deep cervical fascia(cervical visceral fascia).Results:All of the 25 operations were successful with satisfactory effect.The neck incision was 4-5 cm,the operation time was(183.60±25.92)min,the number of lymph node in Ⅱ,Ⅲ-Ⅳ,Ⅴregion were(5.64±3.53),(9.00±3.48)and(6.68±5.00),the hospitalization cost was(15 929.53±4 126.43)yuan.Chylous fistula was found in 4 cases and facial edema occurred in 2 cases after operation.Conclusions:The minimally invasive,safe and cosmetic advantages of endoscopic-assisted improved Miccoli are obvious,and the dissection layer is different from the traditional surgery,this procedure deserves further exploration.
Objective:To study the safety and cosmetic advantage of endoscopic-assisted improved Miccoli lateral neck dissection for thyroid carcinoma.Methods:Twenty-five patients who suffered from papillary thyroid carcinoma underwent endoscopic-assisted lateral neck dissection of Ⅱ,Ⅲ,Ⅳ,Ⅴ region.Self-made retractors were used to build a cavity during surgery.Different from the traditional operation,this operation was working between superficial and deep layer of deep cervical fascia(prevertebral fascia),which was the middle layer of deep cervical fascia(cervical visceral fascia).Results:All of the 25 operations were successful with satisfactory effect.The neck incision was 4-5 cm,the operation time was(183.60±25.92)min,the number of lymph node in Ⅱ,Ⅲ-Ⅳ,Ⅴregion were(5.64±3.53),(9.00±3.48)and(6.68±5.00),the hospitalization cost was(15 929.53±4 126.43)yuan.Chylous fistula was found in 4 cases and facial edema occurred in 2 cases after operation.Conclusions:The minimally invasive,safe and cosmetic advantages of endoscopic-assisted improved Miccoli are obvious,and the dissection layer is different from the traditional surgery,this procedure deserves further exploration.
引文
[1] 董芬,张彪,单广良.中国甲状腺癌的流行现状和影响因素[J].中国癌症杂志,2016,26(1):47-51.
[2] 孙辉,刘晓莉.甲状腺癌规范化诊治理念更新及其意义[J].中国实用外科杂志,2015,35(1):72-75.
[3] Zhang Z,Xu Z,Li Z,et al.Minimally-invasive endoscopically-assisted neck dissection for lateral cervical metastases of thyroid papillary carcinoma[J].Br J Oral Maxillofac Surg,2014,52(9):793-797.
[4] Zhang D,Gao L,Xie L,et al.Comparison Between Video-Assisted and Open Lateral Neck Dissection for Papillary Thyroid Carcinoma with Lateral Neck Lymph Node Metastasis:A Prospective Randomized Study[J].J Laparoendosc Adv Surg Tech A,2017,27(11):1151-1157.
[5] 李百明,陈伟,李扬,等.甲状腺手术合理美容切口的探讨(附175例报告)[J].腹腔镜外科杂志,2015,20(4):262-265.
[6] 赵文新,王波,颜守义,等.针式辅助全腔镜甲状腺癌功能性颈淋巴结清扫的策略与技巧[J].腹腔镜外科杂志,2017,22(4):241-245.
[7] Miccoli P,Elisei R,Materazzi G,et al.Minimally invasive video-assisted thyroidectomy for papillary carcinoma:a prospective study of its completeness[J].Surgery,2002,132(6):1070-1073.
[8] Miccoli P,Elisei R,Berti P,et al.Video assisted prophylactic thyroidectomy and central compartment nodes clearance in two RET gene mutation adult carriers[J].J Endocrinol Invest,2004,27(6):557-561.
[9] Miccoli P,Materazzi G,Berti P.Minimally invasive video-assisted lateral lymphadenectomy:a proposal[J].Surg Endosc,2008,22(4):1131-1134.
[10] Lombardi CP,Raffaelli M,de Crea C,et al.Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma[J].Surgery,2007,142(6):944-951.
[11] Zhang D,Xie L,He G,et al.A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases[J].Am J Otolaryngol,2017,38(2):115-120.
[2] 孙辉,刘晓莉.甲状腺癌规范化诊治理念更新及其意义[J].中国实用外科杂志,2015,35(1):72-75.
[3] Zhang Z,Xu Z,Li Z,et al.Minimally-invasive endoscopically-assisted neck dissection for lateral cervical metastases of thyroid papillary carcinoma[J].Br J Oral Maxillofac Surg,2014,52(9):793-797.
[4] Zhang D,Gao L,Xie L,et al.Comparison Between Video-Assisted and Open Lateral Neck Dissection for Papillary Thyroid Carcinoma with Lateral Neck Lymph Node Metastasis:A Prospective Randomized Study[J].J Laparoendosc Adv Surg Tech A,2017,27(11):1151-1157.
[5] 李百明,陈伟,李扬,等.甲状腺手术合理美容切口的探讨(附175例报告)[J].腹腔镜外科杂志,2015,20(4):262-265.
[6] 赵文新,王波,颜守义,等.针式辅助全腔镜甲状腺癌功能性颈淋巴结清扫的策略与技巧[J].腹腔镜外科杂志,2017,22(4):241-245.
[7] Miccoli P,Elisei R,Materazzi G,et al.Minimally invasive video-assisted thyroidectomy for papillary carcinoma:a prospective study of its completeness[J].Surgery,2002,132(6):1070-1073.
[8] Miccoli P,Elisei R,Berti P,et al.Video assisted prophylactic thyroidectomy and central compartment nodes clearance in two RET gene mutation adult carriers[J].J Endocrinol Invest,2004,27(6):557-561.
[9] Miccoli P,Materazzi G,Berti P.Minimally invasive video-assisted lateral lymphadenectomy:a proposal[J].Surg Endosc,2008,22(4):1131-1134.
[10] Lombardi CP,Raffaelli M,de Crea C,et al.Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma[J].Surgery,2007,142(6):944-951.
[11] Zhang D,Xie L,He G,et al.A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases[J].Am J Otolaryngol,2017,38(2):115-120.