分化型甲状腺癌颈淋巴结转移规律的研究

A clinic study of cervical lymph node metastasis in well-differentiated thyroid carcinoma

目的探讨分化型甲状腺癌患者颈淋巴结的转移规律及分化型甲状腺癌颈部淋巴结外科处理模式。方法回顾性分析2003年1月至2007年6月104例（117侧）行颈淋巴结清扫术的分化型甲状腺癌患者的临床病理资料，其中男性29例，女性75例，年龄12—79岁，中位年龄39岁。根据术前临床体检和影像学检查结果分为临床淋巴结阳性（cN＋）和阴性（cN0）两组，分别与术后病理结果作比较。结果cN＋组69侧颈清扫标本中pN＋者63侧（91．3％），pN0者6侧（8．7％）；cN0组48侧中pN＋者25侧（52．1％），pN0者23侧（47．9％）。颈部转移淋巴结的分布以Ⅵ区最为常见，为64．1％，其次为Ⅱ、Ⅲ、Ⅳ区，分别为31．6％、44．4％、40．2％，V区较少见为12．0％，Ⅰ区最少见为3．2％；cN＋组pN＋者86．7％（54／63）为多个分区转移，cN0组pN＋者64．0％（16／25）为单个分区转移。结论分化型甲状腺癌颈淋巴结转移以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主，尤以Ⅵ区最常见。cN＋组以多个分区转移为主，cN0组以单个分区转移为主，二组患者颈淋巴结的外科处理方式也应有所不同。

Objective To study the distribution of cervical lymph nodes metastasis and explore the surgical treating modality of cervical lymph nodes in the patients with differentiated thyroid carcinoma. Methods The clinic and pathological data of 104 patients with differentiated thyroid carcinoma who had undergone neck lymph nodes dissection from January 2003 to June 2007 were analyzed retrospectively. There were 29 male and 75 female patients. The age of the patients was 12 to 79 years old with a median of 39 years old. Patients were divided into clinic cervical lymph nodes metastasis （cN ＋ ） group and clinic no cervical lymph nodes metastasis （cN0） group according the condition of physical examination and image analysis preoperatively and compared respectively with pathological data postoperatively. Results In the cN ＋ group 91.3% （63/69） patients were pN ＋ while in the cN0 group 52. 1% （25/48） patients were pN ＋. The distribution of metastasized lymph nodes： level Ⅵ 64. 1%, level Ⅱ 31.6%, level Ⅲ 44. 4%, level Ⅳ 40. 2%, level Ⅴ 12.0%, level Ⅰ 3. 2%. In the cN ＋ group 86.7% （ 54/63 ） patients with lymph nodes metastasis had multi-levels lymph nodes metastasis while in the cN0 group 64. 0% （ 16/25 ） patients had single-level lymph nodes metastasis. Conclusions Cervical lymph nodes metastasis in the patients with differentiated thyroid carcinoma mainly localize in level Ⅱ , level Ⅲ, level Ⅳ, levelⅥ, especially level Ⅵ. Patients with lymph nodes metastasis had multi-levels lymph nodes metastasis in the cN ＋ group but single-level in the cN0 group. The surgical treating modality of cervical lymph nodes should also be different in the two group patients.