摘要
目的对甲状腺乳头状癌(PTC)伴上纵隔淋巴结转移的病例进行汇总,以指导临床诊治。方法回顾性分析天津医科大学肿瘤医院2例PTC上纵隔淋巴结转移患者的临床资料,结合文献检索,分析比较不同入路上纵隔淋巴结清扫术。结果2例均为女性,转移淋巴结位置较深,均通过颈部入路行腔镜辅助上纵隔淋巴结清扫。回顾近13年文献,共检索到甲状腺癌伴上纵隔(或Ⅶ区)淋巴结转移的文献13篇,共有1361例患者,其中PTC 1320例。采取颈部入路者1164例,其中286例腔镜辅助;197例转移淋巴结位置较深或与纵隔血管粘连者,采取胸骨劈开入路。结论对于PTC上纵隔淋巴结转移患者,强化CT检查可以弥补B超检查之不足。颈部入路直视下行上纵隔淋巴结清扫,受视野限制,易导致清扫不到位;对于转移淋巴结位置较深者,单从颈部入路无法完成手术,需要胸骨劈开,但患者创伤大,围手术期并发症多。腔镜辅助上纵隔淋巴结清扫,在保证根治的同时减少患者损伤,缩短手术时间,不失为一种好的手术方案。
Objective To summarize the data of papillary thyroid carcinoma(PTC)with superior mediastinal metastasis,so as to guide clinical diagnosis and treatment.Methods The clinical data of two PTC patients with superior mediastinal metastasison in Tianjin Medical University Cancer Hospital were retrospectively analyzed.Combined with literature retrieval,different approaches of mediastinal lymph node dissection were analyzed and compared.Results Both cases were female with deep metastatic lymph nodes and underwent endoscopic-assisted superior mediastinal lymph node dissection(EASMLND).A total of 13 articles of PTC with superior mediastinal(orⅦ)lymph node metastasis were retrieved in the past 13 years.There were a total of 1361 cases,including 1320 cases with PTC.Cervical approach was adopted in 1164 patients,including 286 cases with EASMLND.Sternal split approach was adopted in 197 patients with deep metastatic lymph nodes or close to blood vessels.Conclusions For PTC patients with superior mediastinal lymph node metastasis,enhanced CT examination is necessary for the deficiency of ultrasound examination.Dissection of superior mediastinal lymph nodes by cervical approach is restricted by visual field,which easily leads to incomplete dissection.For patients with deep metastatic lymph nodes,the sternum split is required,which results in large trauma and more perioperative complications.EASMLND is a good surgical scheme,which can not only achieve radical cure,but also reduce the patients’injuries and shorten the operation time.
作者
赵敬柱
郑向前
高明
赵金坤
魏松锋
运新伟
池嘉栋
Zhao Jingzhu;Zheng Xiangqian;Gao Ming;Zhao Jinkun;Wei Songfeng;Yun Xinwei;Chi Jiadong(Department of Thyroid and Neck Tumor,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Department of Radiology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)
出处
《中华普通外科学文献（电子版）》
CAS
2021年第4期293-297,共5页
Chinese Archives of General Surgery(Electronic Edition)
基金
天津市重点研发计划科技支撑重点项目(17YFZCSY00690)。
关键词
甲状腺肿瘤
癌
乳头状
淋巴结转移
上纵隔
腔镜辅助
强化CT
Thyroid neoplasms
Carcinoma,papillary
Lymph node metastasis
Superior media-stinal
Endoscopic-assisted
Enhanced CT
