目的探讨经峡部径路行甲状腺手术的优、缺点。方法回顾性总结分析近8年来我院收治的1 699例患者经峡部径路行甲状腺手术的临床资料。结果该术式术野暴露充分，手术时间平均65 min，术中出血量平均50 ｍl。术后喉返神经损伤8例(均为单侧)，68例术后出现短暂性低钙血症，3例术后出血，其中2例发生于术后2 h，出血量200 ml, 行手术止血； 1例发生于术后1 h，出血量100 ml，给予压迫止血和药物止血后，出血停止，余恢复均好。结论经峡部径路行甲状腺手术，能开阔术野和拓宽手术空间，能立即解除患者颈部紧缩感，保持术野清晰，减少术中出血和喉返神经损伤，减少低钙血症及继发性甲状腺功能低下，避免术后呼吸困难、窒息等并发症的发生。
ObjectiveTo investigate the effect of lymph node dissection in central region on the prognosis of cN0 papillary thyroid microcarcinoma (PTMC).MethodsAccording to the inclusion and exclusion criteria, 300 patients with cN0 PTMC underwent operation in the Second Department of General Surgery of Zhongshan People’s Hospital from January 1, 2007 to May 31, 2016 were retrospectively collected, then who were divided into the central lymph node non-dissection (147 cases) and dissection (153 cases) groups according to whether central lymph node dissection or not. The differences in the incidence of postoperative complications, recurrence rate, and metastasis rate between the two groups were analyzed. The risk factors of central lymph node metastasis of cN0 PTMC were analyzed.ResultsAll patients had no postoperative lymphatic leakage and death. Fifty-nine (38.6%) cases had the lymph node metastasis in the patients with central lymph node dissection. The patients were followed up for (83.0±20.7) months and (79.5±26.2) months (t=1.283, P=0.203) of the non-dissection group (147 cases) and dissection group (153 cases), respectively. During the follow-up period, there was no distant metastasis such as bone metastasis and lung metastasis in both groups; 5 cases recurred in the non-dissection group, 1 case recurred in the dissection group, and there was no significant difference in the recurrence rate between the two groups (χ2=3.008, P=0.089). There was no permanent complications between the two groups. There was no significant difference in the disease-free survival curve (χ2=2.565, P=0.109) between the two groups. The incidence of capsule invasion (P=0.026), calcification (P<0.001), hoarseness (P=0.013), numbness of limbs (P<0.001) in the dissection group were significantly higher than those in the non-dissection group. The results of multivariate analysis showed that the multifocal (OR=24.57, P<0.001), tumor diameter >5 mm (OR=5.46, P=0.019), and capsule invasion (OR=9.42, P=0.002) were the independent risk factors for the lymph node metastasis in the central region.ConclusionsFrom the results of the study, thyroidectomy alone is safe for cN0 PTMC, but the changes of lymph nodes in the central region still need more long-term follow-up. cN0 PTMC patients with tumor diameter >5 mm, multifocal, and capsule invasion are more likely to have lymph node metastasis in the central region. Comprehensive evaluation can be made according to the patient’s condition, and individualized and precise treatment can be carried out.