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目的:探讨分化型甲状腺癌功能性颈清扫术中保留颈丛感觉支的临床应用。方法:随机选取我院2008年1月～2008年7月住院治疗22例临床病理证实的分化型甲状腺癌患者,术前均经B超、CT证实有颈淋巴结肿大,淋巴结包膜完整无融合,根据NCCN分期为N0～N1a的患者,施行保留颈丛感觉支的功能性颈清扫术,观察术后神经功能情况。结果:保留胸锁乳突肌、颈内静脉、副神经及耳大神经22例,枕小神经17例,锁骨上神经18例,颈横动静脉14例。所保留的神经功能随访6个月内均能恢复,上肢活动良好,无颈部肿瘤复发。22例患者术后耳部感觉良好,下颈部及肩部无麻木感。结论:分化性甲状腺癌保留颈清术既能达治疗目的又能提高患者术后的生活质量,值得临床推广应用。
Objective: To investigate the clinical application of preserving cervical plexus sensory branch during functional neck dissection in differentiated thyroid cancer. Methods: A total of 22 patients with differentiated thyroid carcinoma confirmed clinically and pathologically were selected randomly from January 2008 to July 2008 in our hospital. All patients underwent preoperative B-mode ultrasound and CT scan to confirm the presence of cervical lymph node enlargement and lymphatic capsule integrity without fusion According to the NCCN stage N0 ~ N1a patients, functional neck dissection preserving the cervical plexus sensory branch was performed and the postoperative neurological function was observed. Results: 22 cases of sternocleidomastoid, jugular vein, accessory nerve and auricular nerve were preserved, 17 cases of occipital small nerves, 18 cases of supraclavicular nerve and 14 cases of transverse cervical vein. Retained nerve function can be recovered within 6 months follow-up, upper limb activity is good, no neck tumor recurrence. Twenty-two patients felt a good ear, no numbness in the neck and shoulders. Conclusion: The preserving cervical neoplasia of differentiated thyroid cancer can not only achieve the purpose of treatment but also improve the postoperative quality of life of patients, which is worthy of clinical application.