双侧乳头状甲状腺微小癌淋巴结转移及外科处理

Lymph node metastasis in bilateral papillary thyroid microcarcinoma and surgical management

目的研究双侧乳头状甲状腺微小癌患者颈部淋巴结转移的频率及方式，提供最佳外科治疗策略。方法分析2006年3月至2008年8月58例双侧乳头状甲状腺微小癌的性状，颈部淋巴结转移频率、方式及外科治疗。结果58例患者中行双侧甲状腺腺叶全切除44例，一侧腺叶。全切除加对侧腺叶次全切除14例。颈中央区（Ⅵ区）淋巴结清扫加双侧颈内静脉淋巴结链（Ⅱ、Ⅲ、Ⅳ区）切开探查47例，颈Ⅵ区淋巴结清扫加单侧颈部淋巴结清扫10例，双侧颈部淋巴结清扫1例。患者肿瘤平均直径为（6．28±2．23）mm，共26例（44．8％）发生颈部淋巴结转移，双侧乳头状甲状腺微小癌具有明显颈部淋巴结转移倾向（P〈0．05）。88．5％（23／26）患者仅有颈Ⅵ区淋巴结转移，3．8％（1／26）发生颈内静脉旁Ⅱ、Ⅲ、Ⅳ区跳跃性转移；7．7％（2／26）发生颈Ⅵ区伴其他区域转移。结论双侧乳头状甲状腺微小癌具有很高的淋巴结转移发生率，颈Ⅵ区是淋巴结转移好发部位，对于双侧乳头状甲状腺微小癌患者应进行常规颈Ⅵ区淋巴结清扫。

Objective To analyse the frequency and pattern of lymph node metastasis in bilateral papillary thyroid microcarcinoma （PTMC）, and establish the optimal surgical strategy for patients. Methods From March 2006 to August 2008, 58 bilateral PTMC patients received surgical treatment and the tumour characteristics, the frequency and pattern of lymph node metastasis and surgical management of these patients were retrospectively analysed. Results Forty-four patients received total thyroidectomy and 14 patients received near-total thyroidectomy, 47 patients received central compartment （level Ⅵ ） dissection and cervical level Ⅱ, Ⅲ, Ⅳ node exploration by internal jugular vein exposure,10 patients received level Ⅵ dissection and unilateral cervical dissection and 1 patient received bilateral cervical dissection. The mean tumor diameter was （6.28 ± 2.23 ） mm and 26 patients （44.8%） had node involvement, 88.5%（23/26） patients had only level Ⅵ node involvement. Only 1 patient had node involvement in the jugular chain without level Ⅵ node involvement, 2 patients with level Ⅵ node involvement were associated with another cervical compartment nodes involvement. Conclusions Bilateral PTMC has high incidence of lymph node metastasis. The cervical level VI is the most common site of node involvement for bilateral PTMC and the surgical strategy for bilateral PTMC should include the cervical level Ⅵ dissection routinely.