甲状腺乳头状癌Ⅵ区阳性淋巴结数与清除方式的选择

Methods of surgical operation according to the number of region Ⅵ positive lymph nodes in papillary thyroid carcinoma

目的:探讨甲状腺乳头状癌(PTC)中央区(Ⅵ区)阳性淋巴结数与Ⅱ～Ⅴ区淋巴结转移关系,为外科医师提供相对具体的颈部淋巴结清除范围的参考依据。方法:回顾分析95例(130侧)行一侧或双侧功能性淋巴结清除的PTC患者资料,按Ⅵ区阳性淋巴结数分4组:0个(24例),1～2个(31例),3～4个(14例)≥5个(26例),研究Ⅱ～Ⅴ区淋巴结转移情况。结果:随着Ⅵ区阳性淋巴结数的增多,同侧Ⅱ～Ⅴ区淋巴结累及率分别为8.3%、32%、86%和100%(P<0.0001),转移淋巴结个数平均为2、3、6和8枚(P<0.001);对侧Ⅱ～Ⅴ区淋巴结累及率为0、0、40%和67%(P=0.004),对侧Ⅱ～Ⅴ区阳性淋巴结个数平均为0、0、3和7枚(P=0.003)。结论:PTC患者Ⅵ区阳性淋巴结数与Ⅱ～Ⅴ区淋巴结转移有关,对确定颈淋巴结清除的范围、PTC患者个体化治疗有重要意义。

Objective ： To study the quantitative relationships between central （region Ⅵ） and lateral neck （region Ⅱ～Ⅴ） lymph node metastasis in papillary thyroid cancer. Methods： The comparative analysis of region Vl and regions Ⅱ～Ⅴ lymph node metastases was undertaken in 95 cases （130 side） PTC patients with unilateral or bilateral functional lymph node dissection, which were divided into 4 groups by the number of positive lymph nodes： 0 （24 cases）, 1 - 2 （31 cases）, 3-4 （14cases） and ≥ 5 （26 cases）. Results： With the increasement of region Ⅵ positive lymph nodes, the rates and numbers of lateral lymph node metastases in 4 groups were 8.3%, 32%,86%, 100% （P〈0. 000 1） and 2, 3, 6, 8 lymph node metastases （P〈0.O01） in the ipsilateral neck. In the contralateral neck, those were 0%, 0%,40%, 67% （P=0.004） and 0,0,3,7 lymph node metastases （P=0.O03） in the region Ⅱ～Ⅴ lymph node metastases. Those differences Were all statistical significances： Conclusion： These histopathologic associations may provide a foundation for more evidence-based decisions, regarding lymph node dissection of the lateral neck compartments in thyroid cancer patients.