甲状腺乳头状癌Ⅵ区淋巴结的归属

Whether Ⅵ region lymph nodes belong to primary site of the thyroid carcinoma or lateral cervical lymph node metastases

目的 评价临床颈侧区淋巴结阴性 (cN0 )的甲状腺乳头状癌 (PTC)患者行选择性颈侧淋巴结清扫的价值。方法 通过分析 139例PTC患者 (初治时为cN0 )的复发和 (或 )转移部位 (甲状腺 ,Ⅵ区 ,颈侧区 ,远处 ) ,把Ⅵ区淋巴结转移归入原发灶复发 ,明确与颈侧区淋巴结转移的区分 ,逆向分析评价cN0 PTC患者选择性颈侧清扫的临床价值。结果 PTC患者甲状腺复发 83% ( 73/ 88) ,Ⅵ区转移 76 % ( 6 7/ 88) ,17例为已作选择性颈侧淋巴结清扫 ,占 6 5 % ( 17/ 2 6 )。颈侧区淋巴结转移为17% ( 17/ 98) ,其中 5例发生于已作选择性颈侧淋巴结清扫 ,占 19% ( 5 / 2 6 )。结论 支持对cN0 PTC患者行患侧腺叶切除加Ⅵ区清扫 ,不支持颈侧区 (Ⅱ Ⅴ )的选择性颈侧淋巴结清扫。而对初治时为cN0 ,但术前超声和CT为N+的患者 ,则支持行颈侧区淋巴结的选择性清扫。在甲状腺癌诊治中 。

Objective To discuss the evaluation of elective neck dissection (END) for the cN 0 patients with papillary thyroid carcinoma(PTC) Methods By analyzing the recurrent and metastatic region (thyroid, group Ⅵ lymph nodes, lateral neck region, beyond neck)of 139 PTC patients treated secondly in our hospital, group Ⅵ lymph nodal metastasis is divided into recurrence of primary site and distinguished from lateral neck lymph nodes The clinical value of END for cN 0 PTC patients is also retrospectively analyzed Results Thyroidal recurrence accounts for 83%(73/88) Level Ⅵ metastasis accounts for 76%(67/88),17 patients have received END and account for 65%(17/26) Metastasis to lateral neck lymph nodes account for 17%(17/98), among these patients, 5 patients have received END and account for 19%(5/26) Conclusions For the patients with cN 0 PTC, ipsilateral thyroid lobectomy plus level Ⅵ dissection is recommended and lateral END (level Ⅱ Ⅴ) is not supported For the patients with cN 0 but UB N + and/or CT N +, lateral END (level Ⅱ Ⅴ) is recommended The necessarity of CT examination in the diagnosis and treatment of thyroid cancer should be emphasized