预防性同侧中央区颈淋巴结清扫术对临床淋巴结阴性甲状腺微小乳头状癌临床疗效的影响

The clinical efficacy of prophylactic ipsilateral central neck dissection in clinically node-negative papillary thyroid microcarcinoma

目的探讨预防性同侧中央区颈淋巴结清扫术(pCND)在临床淋巴结阴性(cN0)甲状腺微小乳头状癌(PTMC)中的临床疗效。方法216例PTMC患者按照随机数字表法分为观察组和对照组,每组各108例,均接受甲状腺腺叶切除术,观察组手术中予以pCND,对照组内则无此处理(pCND-)。比较两组的组织病理学结果、临床疗效、手术相关并发症及5年无复发生存率等。结果观察组的手术时间长于对照组,但组间住院时间和术后并发症差异无统计学意义(P>0.05)。观察组中隐匿性淋巴转移率为50.0%,淋巴结比率(转移/采集的淋巴结)为46.1%。观察组和对照组分别有13例、12例患者由于存在中央淋巴转移和/或阳性切缘而采取术中或分期根治性甲状腺切除术。截至最后1次随访,对照组1例区域性复发,观察组3例。两组患者的5年无复发生存率比较,差异无统计学意义(P>0.05)。结论同侧pCND一定程度上可有效避免中央区隐匿性淋巴转移,但对cN0 PTMC患者的肿瘤相关临床结局无显著积极影响。

Objective To investigate the clinical efficacy of prophylactic ipsilateral central neck dissection(pCND)in clinically node-negative(cN0)papillary thyroid microcarcinoma(PTMC).Methods 216 patients with PTMC were divided into observation group and control group according to the random number table method,108 cases in each group,and all of them received thyroid lobectomy.The histopathological results,clinical efficacy,surgeryrelated complications and 5-year recurrence-free survival rates were compared between the two groups.Results The operation time in the observation group was longer than that in the control group,but there was no significant difference in hospitalization time and postoperative complications between the groups(P>0.05).The rate of occult lymph node metastasis in the observation group was 50.0%,and the lymph node ratio(metastasized/collected lymph node)was 46.1%.In the observation group and the control group,13 and 12 patients,respectively,underwent intraoperative or staged radical thyroidectomy due to the presence of central lymph node metastasis and/or positive resection margin.As of the last follow-up,there was 1 case of regional recurrence in the control group and 3 cases in the observation group.There was no significant difference in the 5-year recurrence-free survival rate between the two groups(P>0.05).Conclusion Ipsilateral pCND can effectively avoid occult lymph node metastasis in the central region to a certain extent but has no significant positive effect on tumor-related clinical outcomes of cN0 PTMC patients.