甲状腺乳头状癌Ⅵ区淋巴结清扫非劣性研究

Significance of modified radical neck dissection in papillary thyroid carcinoma

目的:了解未行含Ⅵ区的择区性淋巴结清扫术的分化良好的甲状腺乳头状癌患者的复发情况;探讨分化良好的甲状腺乳头状癌是否要常规行含Ⅵ区的择区性颈淋巴结清扫术。方法:不同时期处理的甲状腺乳头状癌患者267例,按时间分成2组:A组为近期行含Ⅵ区的择区性淋巴结清扫的甲状腺乳头状癌151例;B组为早期未行Ⅵ区择区性淋巴结清扫的甲状腺乳头状癌116例。原发灶处理2组均一致:肿瘤发生侧行甲状腺全切除,甲状腺峡部全切,健侧甲状腺次全切除;若肿瘤两侧同时发生,则行双侧甲状腺全切术。统计第1组中Ⅵ区淋巴结转移发生率;随访第2组患者,观察头颈部淋巴结复发情况以及生存情况。结果:A组151例患者中59例仅行Ⅵ区淋巴结清扫,其中发生转移者22例,其余92例同时行Ⅱ、Ⅲ、Ⅳ、Ⅵ区颈淋巴结清扫,其中各区都没有转移者31例,Ⅵ区和其他区均转移者33例(35.8%),只有Ⅵ区颈淋巴结转移者17例(18.4%),除Ⅵ区外其他区域淋巴结有转移者11例(11.9%)。即甲状腺乳头状癌病例中Ⅵ区淋巴结转移率为47.7%(72/151)。B组116例甲状腺乳头状癌伴有颈淋巴结转移者47例,占40.5%;5年生存率为99.3%;复发率为6.0%(7/116)。A组颈淋巴结转移率(54.9%)高于B组(40.5%)。结论:分化良好的甲状腺乳头状癌患者较多的转移到气管前和喉返神经周围淋巴结,Ⅵ区淋巴清扫可成为常规。

Objective：To investigate the recurrence of the neck and survival incidence of clinically possible positive lateral cervical nodes in patients with well-differentiated papillary thyroid cancer and the essentiality of the performation of modified radical neck dissection. Method： Retrospective datum of 267 cases of papillary thyroid carcinoma were collected and ananlyzed. They were divided into two groups with time; selective neck dissection with Ⅵ area was performed in 151 cases of group A and selective neck dissection was performed without Ⅵ area in 116 cased of group B. They were received the same treatment in the thyroid--total thyroidectomy on initial part and subtotal thyrodectomy on the other, and total thyroidectomy on both parts if both were invated. Incidence of positive lateral cerivcal nodes of Ⅵ area in group A and the recurrence in the neck and survival incidence in groups B were analyzed. Result：Fiftynine patients in group A were treated with the modified radical neck dissection, and 22 patients of them were found metastasis in lateral cervical nodes with VI area. The other 92 patients were treated with neck dissection of Ⅱ , Ⅲ, Ⅳ, Ⅵ area, and 31 patients weren＇t metastasis, 33 patients were metastasis in both Ⅵ area and the others（35.8%）, 17 patients were metastasis only in Ⅵ area（18.4%）, 11 patients weren＇t metastasis only in VI area（11.9%）. Thus, the incident of metastasis in Ⅵ area was 47. 70% in groupA（72/151）. 47 patients in group B had metastasis in lateral cervical nodes though without performingⅥ area neck dissection （40.5%）, and the survival rate of 5 years was 99.3%. The recurrence rate in the neck of group two was 6.0% （7/116）. The metastasis rate of neck lymph node was higher in group A （54.9%） than group B（40.5%）. Conelusion：Pretracheal and peripheral recurrent nerve lymph node are very susceptible to the metastasis of well-differentiated papillary thyroid cancer. The neck dissection of Ⅵ area could be performed as routine.