甲状腺乳头状癌淋巴结转移规律的临床研究

Clinical Research on Regularity of Lymph Node Metastasis in Papillary Thyroid Carcinoma

目的 探讨甲状腺乳头状癌颈部淋巴结的转移规律及合理的手术方式。方法回顾性分析我院2004年9月至2009年9月期间收治的221例甲状腺乳头状癌患者的临床资料。结果本组行甲状腺全切除术32例，次全切除术189例。术后病理学诊断单侧甲状腺癌202例（91．40％），双侧甲状腺癌19例（8．60％）。甲状腺的原发肿瘤直径0．2～8．0Cm，平均3．5cm。有包膜侵犯50例；多灶性33例。每侧颈清扫淋巴结数目i0～24个，平均14．3个。颈部淋巴结转移总发生率为37．56％（83／221），中央组（Ⅵ区）淋巴结转移发生率为33．94％（75／221），颈深组（Ⅱ＋Ⅲ＋Ⅳ区）淋巴结转移发生率为18．10％（40／221）。当肿瘤直径〉1．0cm、肿瘤突破甲状腺包膜、多发灶或年龄〉45岁时Ⅵ区及Ⅱ＋Ⅲ＋Ⅳ区的同侧淋巴结转移发生率明显增加（P〈0．05）。结论甲状腺乳头状癌最常见的淋巴结转移为Ⅵ区淋巴结，其次为Ⅱ＋Ⅲ＋Ⅳ区淋巴结，初次手术应常规清扫Ⅵ区淋巴结，当肿块直径〉1．0cm、癌肿突破甲状腺包膜时或B超、CT等影像学检查有颈部淋巴结转移时，应清扫Ⅱ＋Ⅲ＋Ⅳ区淋巴结。

Objective To study the regularity of cervical lymph node metastasis in papillary thyroid carcinoma and a reasonable surgical method. Methods The clinical data of 221 cases of papillary thyroid carcinoma treated in this hospital between September 2004 and September 2009 were analyzed retrospectively. Results There were 32 cases treated with total thyroidectomy, 189 patients with subtotal thyroidectomy. Two hundred and two patients with unilateral thyroid carcinoma and 19 patients with bilateral thyroid carcinoma were diagnosed by pathology. The diameter of tumor was 0.2-8.0 cm with an average of 3.5 cm. The amicula invasion was found in 50 cases and mu- lifocality in 33 cases. The numbers of lymph node dissection were 10-24 with an average of 14.3 in unilateral. The total lymph node metastasis rate was 37.56% （83/221）, the lymph node metastasis rate was 33.94% （75/221） in the VI region, and which was 18.10 % （40/221） in the Ⅱ＋Ⅲ＋Ⅳ region. The rate of cervical lymph node metas- tasis markedly increased in the patients with the primary tumor diameter 〉1.0 cm, amicula invasion, multifocality, or age 〉45 years in the Ⅵ region and ipsilateral of Ⅱ＋Ⅲ＋Ⅳ region （P〈0. 05）. Conclusions In patients with thyroid papillary carcinoma, the most common lymph node metastasis happened in the Ⅵ region, next in theⅡⅢⅣ region. Lymph nodes of the Ⅵ region should routinely be dissected in the first surgery, the lymph nodes of the Ⅱ＋Ⅲ＋Ⅳ region should be dissected when the tumor diameter 〉1.0 cm, amicula invasion, multifocality or ul- trasonic, CT, and other imaging examinations demonstrated cervical lymph node metastasis.