目的：探讨内镜下程序性乳腺淋巴结清扫术（LND）治疗甲状腺乳头状癌的可行性。方法：案例系列研究。回顾性分析2022年1月至11月在深圳市人民医院接受程序性乳腺内镜下LND治疗的39例甲状腺乳头状癌患者的临床资料。其中男10例，女29例，年龄（35.95±10.17）岁。分析LND时间、手术总时间、术中出血量、术后引流量、术后住院时间及术后并发症。结果：39例患者中，单侧甲状腺癌18例，双侧甲状腺癌21例，单侧LND 35例，双侧LND 4例。甲状腺癌病灶最大直径为（1.48±0.69）cm，淋巴结转移最大直径为（1.63±0.58）cm。单侧颈清扫手术时间为（124.11±19.92）min（102~170 min），总手术时间为（226.42±55.68）min（110~390 min）。清扫淋巴结数为（32.40±10.44）（12～54）个，转移及检出数为207/1 393。术后引流量为（174.64±82.33）ml（41～350 ml）。术后无颈部血肿、皮肤烧伤、耸肩等异常情况。颈部皮肤感觉麻木不适7例，半年后逐渐缓解。术后出院时间(4.77±1.94)d(3-15d)。结论:内镜下LND程序化乳腺入路治疗甲状腺乳头状癌安全可行,可提高手术效率和临床应用价值。

Objective: To explore the feasibility of endoscopic lymph node dissection(LND) with programmed breast approach for the treatment of papillary thyroid cancer. Methods: A case series study. The clinical data of 39 patients with papillary thyroid cancer who underwent endoscopic LND treatment with programmed breast approach in Shenzhen People's Hospital from January to November 2022 were retrospectively analyzed. There were 10 males and 29 females, aged (35.95±10.17) years. LND time, total surgical time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay and postoperative complications were analyzed. Results: Among 39 patients, there were 18 cases of unilateral thyroid cancer, 21 cases of bilateral thyroid cancer, 35 cases of unilateral LND, and 4 cases of bilateral LND. The maximum diameter of thyroid cancer lesions was (1.48±0.69) cm, and the maximum diameter of lymph node metastases was (1.63±0.58)cm. The operative time of unilateral neck dissection was (124.11±19.92) min (102-170 min), and the total operative time was (226.42±55.68) min (110-390 min). The number of lymph nodes cleaned was (32.40±10.44)(12-54), the number of metastasis and detection was 207/1 393. The postoperative drainage volume was (174.64±82.33) ml(41-350 ml). There were no neck hematomas, no skin burns or no shrugging disorders in the postoperative period. There were 7 cases of numbness and discomfort in neck skin sensation, which gradually relieved after half a year. Postoperative discharge time (4.77±1.94) d(3-15 d). Conclusion: It is safe and feasible to treat papillary thyroid cancer with endoscopic LND with programmed breast approach, which can improve surgical efficiency and clinical application value.