Ⅵ区淋巴结清扫在甲状腺乳头状癌手术治疗中的应用

Application of central lymph node dissection to surgical operation for papillary thyroid carcinoma

目的探讨甲状腺乳头状癌患者Ⅵ区淋巴结处理的恰当方案。方法选择2007～2009年60例经术前常规B超、颈部CT检查未见颈部肿大淋巴结的甲状腺乳头状癌患者。60例分为2组:Ⅰ组行原发灶根治+Ⅵ区淋巴结清扫术(30例),Ⅱ组行原发灶根治+Ⅵ区淋巴结清扫术+颈部淋巴结清扫术(30例),术后均服甲状腺素超量抑制内分泌治疗。结果Ⅰ组Ⅵ区淋巴结转移阳性率为36.7%(11/30),Ⅵ区淋巴结转移阳性患者行同侧淋巴结清扫术,淋巴结转移阳性率为25.0%。结论原发灶根治+Ⅵ区淋巴结清扫是治疗甲状腺乳头状癌的一种值得推荐的术式,在原发灶根治术的基础上减少再次手术对甲状腺区的损伤。

Objective To explore a suitable method to dissect cervical lymph nodes for stage cN0 papillary thyroid carcinoma（PTC）patients.Methods Sixty stage cN0PTC patients,diagnosed by B ultrasound or cervical CT from the year 2007～2009,were randomly divided into two groups.Thyroidectomy and central lymph node dissection were performed in Group Ⅰ,while thyroidectomy,central lymph node dissection and cervical dissection was performed is Group Ⅱ.Each group contained 30 patients.Both groups took enough thyroxin tablets after operation.Results An average of 36.7% positive lymph nodes were found in Group Ⅰ.The lymph node cervical dissection metastas rate was 25.0%.Conlusion Thyroid ectomy plus central lymph node dissection is recommended for the treatment of stage cN0PTC.It can also avoid damage of thyroid area by reoperations.