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目的 :探讨保留颈丛神经技术在分化性甲状腺癌改良根治术中的应用。方法 :103例甲状腺乳头状癌患者,行保留颈丛神经的功能性颈清扫术,采用传统的不解剖颈丛和本研究改进的解剖颈丛2种术式。1N0、N1a分化型甲状腺癌,或颈内静脉旁淋巴结较小(N<3 cm)无包膜外侵犯者,可不解剖颈丛行传统的保留颈丛的颈清扫术;2N1b的分化型甲状腺癌、淋巴结转移较多者,需常规分离皮瓣后、应用解剖技术保留颈丛神经。术后采用轻触、针刺、冷热法刺激患侧颈部皮肤,以健侧为对照测知感觉。以肉眼判断有无完全显露颈清扫要达到的解剖结构为达标。结果:2种颈丛神经保护法均能达到颈清扫要求。术后全部下颈部及肩部无麻木感,耳部感觉良好。结论:解剖颈丛保留颈丛的技术拓宽了分化性甲状腺癌保留颈丛的适应证,同样能保护颈部感觉。
Objective: To explore the application of the technique of preserving the cervical plexus in the modified radical mastectomy of differentiated thyroid cancer. METHODS: A total of 103 patients with papillary thyroid carcinoma underwent functional neck dissection with cervical plexus preservation. Two types of surgical procedures were adopted, which were not anatomic cervical plexus and modified cervical plexus. 1N0, N1a differentiated thyroid cancer, or less adjacent jugular vein lymph nodes (N <3 cm) without extracapsular encroachment, cervical spondylolisthesis may not be anatomized cervical neck dissection; 2N1b differentiated thyroid cancer , Lymph node metastasis more, need to be separated after the normal flap, the application of anatomical techniques to retain the cervical plexus. After surgery using light touch, acupuncture, hot and cold stimulation of the affected side of the skin of the neck, the contralateral control for feeling. With the naked eye to determine whether the neck completely clear to reach the anatomical structure to achieve compliance. Results: The two kinds of cervical plexus nerve protection method can meet the requirements of neck dissection. All under the neck and shoulders no numbness, ears feel good. CONCLUSIONS: The technique of dissecting the cervical plexus to preserve the cervical plexus broadens the indication of preserving the cervical plexus in differentiated thyroid cancer and also protects the neck.