经胸乳入路腔镜下选择性侧颈区淋巴结清扫20例临床分析
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摘要
目的:探索腔镜下选择性侧颈区淋巴结清扫的可行性。方法:对2017-01-2018-05期间收治的20例甲状腺乳头状癌伴侧颈部淋巴结转移患者,采用经胸乳入路甲状腺全切除加中央区淋巴结清扫加选择性侧颈区淋巴结清扫术。结果:20例患者均在腔镜下完成甲状腺全切加同侧中央区淋巴结清扫及选择性侧区淋巴结手术。1例发生淋巴漏,1例短暂性声嘶,4例短暂性甲状旁腺功能减退,1例颈内静脉损伤和1例颈外静脉损伤,余未发生其他严重并发症。结论:经胸乳入路腔镜下行侧颈Ⅱ、Ⅲ、Ⅳ区淋巴结清扫术是可行的,美容性好,患者满意度高,未见严重并发症发生,是一种可行的治疗方式。
Objective: To explore the feasibility of endoscopic selective lateral neck dissection(SLND) via a chest-breast approach. Method: We retrospectively reviewed 20 patients who underwent endoscopic total thyroidectomy along with SLND, between January 2017 and May 2018. Result: All the 20 patients underwent total thyroidectomy, central lymph nodes dissection and selective lateral lymph nodes dissection with endoscopic surgery via chest-breast approach. In this study, lymphatic leakage, transient voice hoarseness, internal jugular vein injury and external jugular vein injury were repectively found in one patient, and 4 patients suffered from transient parathyroid hypofunction, without other serious complications. Conclusion: Endoscopic lymph node dissection including levels Ⅱ, Ⅲ and Ⅳ is feasible. It has good cosmetic effect, and haven't serious adverse events.
Objective: To explore the feasibility of endoscopic selective lateral neck dissection(SLND) via a chest-breast approach. Method: We retrospectively reviewed 20 patients who underwent endoscopic total thyroidectomy along with SLND, between January 2017 and May 2018. Result: All the 20 patients underwent total thyroidectomy, central lymph nodes dissection and selective lateral lymph nodes dissection with endoscopic surgery via chest-breast approach. In this study, lymphatic leakage, transient voice hoarseness, internal jugular vein injury and external jugular vein injury were repectively found in one patient, and 4 patients suffered from transient parathyroid hypofunction, without other serious complications. Conclusion: Endoscopic lymph node dissection including levels Ⅱ, Ⅲ and Ⅳ is feasible. It has good cosmetic effect, and haven't serious adverse events.
引文
[1] 亚明宏.2012年中国版《甲状腺结节和分化型甲状腺癌诊治指南》解读[J].临床耳鼻咽喉头颈外科杂志,2013,27(16):917-920.
[2] HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26:1-133.
[3] CRACCHIOLO J R,WONG R J.Management of the lateral neck in well differentiated thyroid cancer[J].Eur J Surg Oncol,2018,44:332-337.
[4] HU D,ZHOU J,HE W,et al.Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma[J].World J Surg Oncol,2018,16:30-34.
[5] LEI J,ZHONG J,JIANG K,et al.Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma[J].Oncotarget,2017,8:27022-27033.
[6] LUO D C,XU X C,DING J W,et al.Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma[J].Oncotarget,2017,79897-79905.
[7] 王平,项承.经胸前入路腔镜甲状腺手术专家共识(2017版)[J].中国实用外科杂志,2017,23(12):1369-1373.
[8] KIM W S,KOH Y W,BYEON H K,et al.Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases[J].J Laparoendosc Adv Surg Tech A,2014,24:367-372.
[9] GOEPFERT R P,LIU C,RYAN W R.Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma[J].Am J Otolaryngol,2015,36:710-714.
[10] NARDUCCI F,LAMBAUDIE E,MAUTONE D,et al.Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in gynecologic oncology:preliminary experience and advantages and limitations[J].Int J Gynecol Cancer,2015,25:1494-1502.
[11] LEE J,KWON I S,BAE E H,et al.Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases[J].J Clin Endocrinol Metab,2013,98:2701-2708.
[12] KANDIL E,HAMMAD A Y,WALVEKAR R R,et al.Robotic Thyroidectomy versus nonrobotic approaches:a meta-analysis examining surgical outcomes[J].Surg Innov,2016,23:317-325.
[13] 傅锦波,罗晔哲,洪晓泉,等.经腋窝入路与经胸乳入路腔镜甲状腺切除术的对比研究[J].中国微创外科杂志,2017,17(8):688-690.
[14] 郑传铭,毛晓春,王佳峰,等.无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会[J].中国肿瘤临床,2018,45(1):27-32.
[15] 王平,燕海潮.腔镜下全乳晕入路甲状腺腺叶切除的方法——王氏七步法[J].中国普通外科杂志,2017,26(5):541-546.
[16] 赵霞,张能维,朱斌,等.经胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤对比研究[J].中国实用外科杂志,2011,31(5):423-425.
[17] LI Z,WANG P,WANG Y,et al.Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma:a preliminary report[J].Surg Endosc,2011,25:890-896.
[18] CARON N R,TAN Y Y,OGILVIE J B,et al.Selective modified radical neck dissection for papillary thyroid cancer-is level Ⅰ,Ⅱ and Ⅴ dissection always necessary[J]?World J Surg,2006,30:833-840.
[19] KIM S K,PARK I,HUR N,et al.Should level V be routinely dissected in n1b papillary thyroid carcinoma[J]?Thyroid,2017,27:253-260.
[20] QU R,WANG C,DONG Z,et al.Another strategy for the treatment of thyroglossal duct cyst:totally endoscopic surgery by breast approach[J].Surg Laparosc Endosc Percutan Tech,2018,28:118-122.
[21] QU R,GUO Y,HU X,et al.Endoscopic thyroid surgeries via areola approach:experience and outcomes of 500 cases in a single institute[J].Indian J Surg,2018,13:1-6.
[22] 瞿锐,刘道生,郭又铭,等.完全经乳晕路径腔镜手术治疗甲状腺乳头状癌的临床效果[J].中国基层医药,2017,24(17):2581-2584.
[23] 冯志起,李进义,王存川.经乳晕入路腔镜甲状腺切除术治疗男性患者的困难及对策[J].腹腔镜外科杂志,2014,21(4):271-274.
[24] 王宇,杨舒雯,李端树.甲状腺癌手术中喉返神经监测的临床应用[J].中国癌症杂志,2017,21(6):432-436.
[25] 邓正明,孔凡萍,葛少华,等.纳米碳混悬液在甲状腺癌颈部淋巴结清扫和甲状旁腺保护中的临床应用[J].南京医科大学学报(自然科学版),2016,20(12):1456-1460.
[26] 陈万志,吕云霞,谢嵘,等.纳米碳在甲状腺癌手术中甲状旁腺保护的应用[J].临床耳鼻咽喉头颈外科杂志,2014,28(24):1918-1920.
[27] 王兴,朱一鸣,黄辉,等.甲状腺癌术中甲状旁腺误切危险因素分析[J].中国实用外科杂志,2017,23(9):1028-1031.
[28] 刘跃武,王梦一.内镜甲状腺手术入路的选择[J].腹腔镜外科杂志,2011,18(8):580-582.
[29] 苏磊,桑剑锋,姚永忠,等.经胸乳入路腔镜甲状腺切除的手术技巧[J].中国普外基础与临床杂志,2013,25(5):512-516.
[30] NAKAJO A,ARIMA H,HIRATA M,et al.Bidirectional Approach of Video-Assisted Neck Surgery(BAVANS):Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer[J].Asian J Endosc Surg,2017,10:40-46.
[31] 葛明华,刘爱华.无区域淋巴结转移甲状腺乳头状癌患者的颈部处理[J].中国肿瘤临床,2001,4(1):14-16.
[2] HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26:1-133.
[3] CRACCHIOLO J R,WONG R J.Management of the lateral neck in well differentiated thyroid cancer[J].Eur J Surg Oncol,2018,44:332-337.
[4] HU D,ZHOU J,HE W,et al.Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma[J].World J Surg Oncol,2018,16:30-34.
[5] LEI J,ZHONG J,JIANG K,et al.Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma[J].Oncotarget,2017,8:27022-27033.
[6] LUO D C,XU X C,DING J W,et al.Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma[J].Oncotarget,2017,79897-79905.
[7] 王平,项承.经胸前入路腔镜甲状腺手术专家共识(2017版)[J].中国实用外科杂志,2017,23(12):1369-1373.
[8] KIM W S,KOH Y W,BYEON H K,et al.Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases[J].J Laparoendosc Adv Surg Tech A,2014,24:367-372.
[9] GOEPFERT R P,LIU C,RYAN W R.Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma[J].Am J Otolaryngol,2015,36:710-714.
[10] NARDUCCI F,LAMBAUDIE E,MAUTONE D,et al.Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy in gynecologic oncology:preliminary experience and advantages and limitations[J].Int J Gynecol Cancer,2015,25:1494-1502.
[11] LEE J,KWON I S,BAE E H,et al.Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases[J].J Clin Endocrinol Metab,2013,98:2701-2708.
[12] KANDIL E,HAMMAD A Y,WALVEKAR R R,et al.Robotic Thyroidectomy versus nonrobotic approaches:a meta-analysis examining surgical outcomes[J].Surg Innov,2016,23:317-325.
[13] 傅锦波,罗晔哲,洪晓泉,等.经腋窝入路与经胸乳入路腔镜甲状腺切除术的对比研究[J].中国微创外科杂志,2017,17(8):688-690.
[14] 郑传铭,毛晓春,王佳峰,等.无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会[J].中国肿瘤临床,2018,45(1):27-32.
[15] 王平,燕海潮.腔镜下全乳晕入路甲状腺腺叶切除的方法——王氏七步法[J].中国普通外科杂志,2017,26(5):541-546.
[16] 赵霞,张能维,朱斌,等.经胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤对比研究[J].中国实用外科杂志,2011,31(5):423-425.
[17] LI Z,WANG P,WANG Y,et al.Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma:a preliminary report[J].Surg Endosc,2011,25:890-896.
[18] CARON N R,TAN Y Y,OGILVIE J B,et al.Selective modified radical neck dissection for papillary thyroid cancer-is level Ⅰ,Ⅱ and Ⅴ dissection always necessary[J]?World J Surg,2006,30:833-840.
[19] KIM S K,PARK I,HUR N,et al.Should level V be routinely dissected in n1b papillary thyroid carcinoma[J]?Thyroid,2017,27:253-260.
[20] QU R,WANG C,DONG Z,et al.Another strategy for the treatment of thyroglossal duct cyst:totally endoscopic surgery by breast approach[J].Surg Laparosc Endosc Percutan Tech,2018,28:118-122.
[21] QU R,GUO Y,HU X,et al.Endoscopic thyroid surgeries via areola approach:experience and outcomes of 500 cases in a single institute[J].Indian J Surg,2018,13:1-6.
[22] 瞿锐,刘道生,郭又铭,等.完全经乳晕路径腔镜手术治疗甲状腺乳头状癌的临床效果[J].中国基层医药,2017,24(17):2581-2584.
[23] 冯志起,李进义,王存川.经乳晕入路腔镜甲状腺切除术治疗男性患者的困难及对策[J].腹腔镜外科杂志,2014,21(4):271-274.
[24] 王宇,杨舒雯,李端树.甲状腺癌手术中喉返神经监测的临床应用[J].中国癌症杂志,2017,21(6):432-436.
[25] 邓正明,孔凡萍,葛少华,等.纳米碳混悬液在甲状腺癌颈部淋巴结清扫和甲状旁腺保护中的临床应用[J].南京医科大学学报(自然科学版),2016,20(12):1456-1460.
[26] 陈万志,吕云霞,谢嵘,等.纳米碳在甲状腺癌手术中甲状旁腺保护的应用[J].临床耳鼻咽喉头颈外科杂志,2014,28(24):1918-1920.
[27] 王兴,朱一鸣,黄辉,等.甲状腺癌术中甲状旁腺误切危险因素分析[J].中国实用外科杂志,2017,23(9):1028-1031.
[28] 刘跃武,王梦一.内镜甲状腺手术入路的选择[J].腹腔镜外科杂志,2011,18(8):580-582.
[29] 苏磊,桑剑锋,姚永忠,等.经胸乳入路腔镜甲状腺切除的手术技巧[J].中国普外基础与临床杂志,2013,25(5):512-516.
[30] NAKAJO A,ARIMA H,HIRATA M,et al.Bidirectional Approach of Video-Assisted Neck Surgery(BAVANS):Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer[J].Asian J Endosc Surg,2017,10:40-46.
[31] 葛明华,刘爱华.无区域淋巴结转移甲状腺乳头状癌患者的颈部处理[J].中国肿瘤临床,2001,4(1):14-16.