Ⅵ区淋巴清扫在甲状腺癌外科手术中的意义(2)
本次研究,cN1患者Ⅵ区淋巴结阳性率在术后为85.3%,和cN0患者Ⅵ区淋巴阳性率比较无明显差异,故不论对何种疾病类型,及时清理Ⅵ区淋巴结,再行病理检查,以为更好的治疗提供参考依据。本次6例有手术并发症,主要为喉返神经损伤、积液和感染等,Ⅵ区的并发症具有可预防性,手术技巧的娴熟和手术医生专业知识扎实对解剖结构掌握深入对预防并发症的发生有着重要意义,有学者建议可在对Ⅵ区淋巴清扫时在气管食管沟将喉返神经暴露,可对Ⅵ区淋巴在直视下清扫,对喉上神经做好保护[7],术中应行冰冻切片,做好病理检查。甲状腺癌淋巴转移对预防是否存在影响仍存在争议,Noguchi[8]报道行淋巴清扫对甲状腺癌患者的预防起到改善作用,甲状腺癌的首站转移区是Ⅵ区,故进行常规清扫可降低淋巴向其它区域转移的发生率,明显改善甲状腺癌患者的生命质量。
参考文献:
[1] MITCHELL I,LIVINGSTON FH,CHANGAY,et al.Trends in thyroid cancer demographics and surgical therapy in the United States[J].2007,42(6):823-828.
[2] 王志明,李新营,吕新生,等.甲状腺的外科治疗[J].中国普通外科杂志,2002,11(5):263-265.
[3] Robbins K T.Pocket guide to neck dissection classification and TNM staging of head and neck cancer[M].Alexandria,American Academy of Otolaryngology-Head and Neck Surgery Foundation,Inc,Va22314,USA 1991:9-20.
[4] 范西红,张小桥.分化性甲状腺癌手术治疗的研究进展[J].实用医药杂志,2004,21(7):657-660.
[5] 吴毅.分化性甲状腺癌外科治疗的有关问题[J].中国实用外科杂志,2004,24(10):577-578.
[6] Roy B,Terry T,Carrie A.Cancer of the thyroid gland [A].Louis B,Roy B,Waun KH.Head and neck cancer:A multidisciplinary approach[M].Philadelphia:Lippinco tt-raven,1988:807-808.
[7] 殷玉林,李庆宏,唐平章.甲状腺手术喉返神经解剖198例报告[J].临床耳鼻喉科杂志,2005,19(9):385-386.
[8] Noguchi S,Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer[J].Surg Clin North Am,1987,67(2):251-261., 百拇医药(张悦 周鑫)
参考文献:
[1] MITCHELL I,LIVINGSTON FH,CHANGAY,et al.Trends in thyroid cancer demographics and surgical therapy in the United States[J].2007,42(6):823-828.
[2] 王志明,李新营,吕新生,等.甲状腺的外科治疗[J].中国普通外科杂志,2002,11(5):263-265.
[3] Robbins K T.Pocket guide to neck dissection classification and TNM staging of head and neck cancer[M].Alexandria,American Academy of Otolaryngology-Head and Neck Surgery Foundation,Inc,Va22314,USA 1991:9-20.
[4] 范西红,张小桥.分化性甲状腺癌手术治疗的研究进展[J].实用医药杂志,2004,21(7):657-660.
[5] 吴毅.分化性甲状腺癌外科治疗的有关问题[J].中国实用外科杂志,2004,24(10):577-578.
[6] Roy B,Terry T,Carrie A.Cancer of the thyroid gland [A].Louis B,Roy B,Waun KH.Head and neck cancer:A multidisciplinary approach[M].Philadelphia:Lippinco tt-raven,1988:807-808.
[7] 殷玉林,李庆宏,唐平章.甲状腺手术喉返神经解剖198例报告[J].临床耳鼻喉科杂志,2005,19(9):385-386.
[8] Noguchi S,Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer[J].Surg Clin North Am,1987,67(2):251-261., 百拇医药(张悦 周鑫)