cN0甲状腺乳头状癌手术方案选择临床分析

Clinical Analysis on Optimized Surgical Approach for Clinical Stage N_0 Papillary Thyroid Carcinoma

目的:探讨甲状腺乳头状癌(PTC)临床淋巴结阴性(cN)0患者手术方案选择。方法:分析2007年1月-2010年1月127例cN0PTC患者临床资料,根据术前临床分期及术中冰冻病理分期,113例行选择性颈部淋巴结清扫术:中央区淋巴结清扫术44例,扩大中央区淋巴结清扫术13例,功能性颈部淋巴结清扫术56例。分析比较淋巴结转移情况和各组淋巴结转移间的关系。结果:清扫淋巴结病理检查示隐性转移率30.1%(34/113);不同肿瘤侵犯范围和年龄的Ⅵ区淋巴结转移率差异有统计学意义(均P<0.05);不同性别及体质量指数的Ⅵ区淋巴结转移率间差异无统计学意义(P>0.05);Ⅱ～Ⅳ区淋巴结转移与Ⅵ区淋巴结转移情况存在相关性(r=0.610,P<0.01)。结论:cN0PTC患者应行中央区淋巴结清扫术,对高危转移患者可考虑扩大中央区行淋巴结清扫术。

Objective： To investigate the selection of surgical operation for clinical stage N0 （cN0） papillary thyroid carcinoma （PTC）. Methods：The clinical data of 127 patients of PTC with cN0 from January 2007 to January 2010 were analyzed. According to the preoperativeclinicalstaging andpathological staging of intraoperative frozen, 113 cases underwent selective cervical lymphadenectomy, 44 cases with central lymph node dissection, 13 cases with the expanded central lymph node dissection and 56 cases with the functional neck lymph node dissection. The differences between various sets of lymph nodes metastasis data were compared between groups. Results： In 113 cases,30.1% （34/113） of all cases showed implicit lymph nodes metastasis. There were significant differences in lymph node metastasis （Ⅵ area） between different extents of tumor invasion and different age groups （P〈0.05）. There were no significant differences between lymph node metastasis, gender and body mass index （BMI） （P〈0.05）. The lymph node metastasis rate （Ⅱ-Ⅳ area） was significantly correlated with the lymph node metastasis （Ⅵ area） （r = 0.610,P〈0.01）. Conclusion： Patients with cN0 PTC should be performed the central lymph node dissection. Furthermore, the expanded central lymph node dissection should be performed in patients at high risk for lymph node metastasis.