分化型甲状腺癌行颈部淋巴结清扫的意义及方式探讨

The choice and significance of neck lymph node dissection for differentiated thyroid carcinoma

目的探讨分化型甲状腺癌行颈部淋巴结清扫的意义及手术方式的选择。方法自2007年1月至2010年6月山东省聊城市人民医院手术治疗分化型甲状腺癌病人428例(506侧),其中在标准甲状腺癌改良根治术基础上简化操作过程(简称简化术式)完成手术349例侧。术后分组检测各区淋巴结转移发生率,比较不同手术方法术后并发症。结果本组中行中央区淋巴结(Ⅵ区)清扫者441例侧,转移发生率为52.83%(233/441);行颈侧区淋巴结清扫(Ⅱa、Ⅲ、Ⅳ、Ⅴb区)者385例侧,转移发生率为44.42%(171/385),其中Ⅱa区23.98%、Ⅲ区67.84%、Ⅳ区53.80%、Ⅴb区4.68%。结论分化型甲状腺癌即便是微小癌也有较高的颈部淋巴结转移发生率。对于临床颈侧区淋巴结阴性(cN0)病人也应常规行颈部淋巴结清扫术,以消除病变遗漏及复发隐患,全面准确评价颈部淋巴结状态。简化甲状腺癌改良根治术最大程度的降低了创伤,更加符合功能性根治的原则,适应证广泛,值得推广应用。

Objective To explore the operation mode choice and significance of neck lymph node dissection for differentiated thyroid carcinoma （DTC）. Methods From January 2007 to June 2010, 428 cases （506 sides） of DTC were treated by operations at Liaocheng People＇ s Hospital of Shandong Province. Among them, 349 cases performed simplified operative procedure depended on standard modified radical thyroidectomy. The lymph nodes of neck were evaluated separately. The complications of different operation modes were compared. Results Four hundreds and forty-one sides performed central lymph node dissection（ Ⅵ ） with metastasis rate of 52.83%. Three hundreds and eighty-five sides performed lateral lymph node dissection （ Ⅱ a, Ⅲ, Ⅳ, Ⅴ b ） with metastasis rate of 44.42%, among which Ⅱa area, Ⅲarea, Ⅳ area and V b area accounted for 23.98%, 67.84%, 53.80% and 4.68% respectively. Conclusion DTC has high metastasis rate even if it is microcarcinoma. So the patients of cN0 should performed lymph node dissection to decrease the possibility of recurrence and evaluate the clinical stage. Simplified modified radical thyroidectomy is valuable to be promoted because it is closer to the principle of functional radical dissection with less trauma and more indications.