甲状腺乳头状腺癌颈清扫的争议

Controversies in neck dissection of papillary thyroid carcinoma

甲状腺乳头状腺癌颈淋巴结转移率较高是其特点之一，多数认为临床阴性者无需行预防性颈清扫术，治疗性清扫以颈改良性清扫术为标准治疗术式。颈清扫的范围越来越多的处于争议之中，Ⅰ区不必常规清扫，Ⅱ区倾向于包括，Ⅴ区的清扫对颈肩部功能有不同程度的影响，低危者可以观察，密切随访，一旦复发及时治疗。常规中央区清扫有助于降低复发率。择区性清扫术在甲状腺乳头状腺癌中的应用还有待于进一步研究和确定。

Parpillary adenocarcinoma is the most common type of thyroid cancer with high probability of cervicel lymph node metastasis. Prophylactic neck dissection is not necessary for patients with clinical negative neck. Modified radical neck dissection is the standard for therapeutic neck dissection. The range of dissection remains controversial. Level Ⅰ is not included routinely, level Ⅱ is recommended. Dissection of level Ⅴ may cause malfunction of the neck and shoulder, clinical negative level Ⅴ for low-risk group can be avoided with close follow-up. Rountine central lymph node dissection tends to reduce the local recurrence. Selective neck dissection for thyroid parpillary adenoearcinoma needs more investigations.