Ⅵ区淋巴清扫在甲状腺癌外科手术中的意义

Significance of Level VI Neck Dissection in Surgical Operation for Thyroid Cancer

背景与目的:Ⅵ区是甲状腺癌常见的淋巴转移区域,对cN1患者可常规行包括Ⅵ区的淋巴清扫手术,然而对于cN0患者是否需要常规清扫Ⅵ区,目前仍没有一个明确的指引。本研究探讨甲状腺癌Ⅵ区淋巴转移的特点,并明确甲状腺癌手术治疗中Ⅵ区淋巴清扫的意义。方法:回顾性分析1988年1月～2000年1月期间收治的均行含Ⅵ区在内的颈淋巴清扫手术的130例甲状腺癌患者的临床资料,并对此资料进行统计学处理。结果:130例患者中术后Ⅵ区淋巴结阳性者97例(74.6%);并发症发生率为10.8%(14/130),其中包括喉返神经损伤4例;多因素生存分析表明甲状腺癌Ⅵ区淋巴转移是影响患者生存的因素。结论:对甲状腺癌患者常规行Ⅵ区淋巴清扫有助于改善其生存情况;可以通过提高手术技巧降低手术的并发症发生率。

BACKGROUND ＆ OBJECTIVE： Patients with thyroid cancer often come along with level Ⅵ lymph nodal metastasis. Neck dissection, which includes level Ⅵ, is routinely performed on cN1 patients, but whether cN0 patients need routine level Ⅵ neck dissection is uncertain. This study was to explore the rule of level Ⅵ lymph nodal metastasis in thyroid cancer and the significance of level VI neck dissection in surgical operation for thyroid cancer. METHODS： Clinical data of 130 patients with thyroid cancer, who received level Ⅵ neck dissection from Jan. 1988 to Jan. 2000, were analyzed retrospectively. RESULTS： Of the 130 patients, 97 had level Ⅵ lymph node metastasis, 14 （10.8%） had post-operative complications, including 4 cases of recurrent laryngeal nerve injury. Multivariate survival analysis indicated that level Ⅵ lymph nodal metastasis was correlated to the survival of thyroid cancer patients. CONCLUSIONS： Routine level Ⅵ neck dissection may be helpful to improve the survival of thyroid cancer patients. Meanwhile, complication could be decreased by improving surgical skills.