甲状腺乳头状癌中央区淋巴结清扫的临床意义

Clinical significance of central lymph node dissection for papillary thyroid carcinoma

[目的]探讨甲状腺乳头状癌行中央区淋巴结清扫的临床意义。[方法]2007年3月-2010年2月间行手术治疗的61例甲状腺乳头状癌患者中,因颈前区无痛性包块入院36例,颈淋巴结肿大入院5例,声音嘶哑就诊2例,体检发现甲状腺结节18例。行患侧叶、峡部全切、对侧叶大部切除术46例,甲状腺全切除术15例。传统根治性颈淋巴结清扫术3例,功能性颈淋巴结清扫术26例,选择性颈淋巴结清扫术32例。分析其颈淋巴结转移规律。[结果]单侧甲状腺癌47例,双侧甲状腺癌11例,峡部甲状腺癌3例。共清扫淋巴结511枚,其中136枚淋巴结见癌转移。淋巴结癌转移率26.6%。无论肿瘤大小,是否侵及甲状腺被膜,是否侵及颈前肌群,其中央区淋巴结转移率均明显高于颈侧区(P<0.05)。肿瘤直径>1.0 cm,肿瘤穿透甲状腺被膜,肿瘤侵及颈前肌群者,其中央区淋巴结转移率及同侧颈侧区淋巴结转移率均明显增高(P<0.05)。术后随访0.5～3年,3例局部复发,行再次手术;2例再次手术后出现远处转移。随访期间无死亡病例。[结论]甲状腺乳头状癌中央区淋巴结转移率高于颈侧区,对cN1患者需常规行中央区淋巴结清扫术。而对cN0患者初始手术时也宜同时行中央区淋巴结清扫术。

[ Objective] To investigate the significance of the central group neck dissection for papillary thyroid carcinoma. [Methods] Clinical data of papillary thyroid carcinoma, in 61 cases diagnosed by surgery from March 2007 to February 2010 were analyzed retrospectively, among which there were 36 cases of anterior cervical region painless mass on admis- sion, 5 cases of cervical lymph node enlargement, 2 eases of hoarseness, 18 cases of thyroid nodules revealed by physical examination. Forty - six cases received total affected thyroidectomy plus isthmus and opposite subtotal thyroidectomy and 15 cases took total thyroidecyomy. Three cases were treated with radical lymph node dissection, 26 cases were performed with functional lymph node dissection, and 32 cases obtained selective lymph node dissection. [ Results ] Unilateral papillary thyroid carcinoma was found in 47 cases, bilateral in 11 cases and isthmus in 3 cases. The total rates of cervical lymph node metastasis were 26.6% （136/511）. Metastasis rate of central group lymph node was higher obviously than those of lateral group, no matter how tumor size, whether extrathyroid tumor invasion and precervieal muscle invasion were or not （ P 〈 0.05 ）. Metastasis rates of lymph node in both central and lateral groups were high significantly when tumor diameter was more than 1.0em and invasion thyroid capsule and invasion precervieal muscle were appeared （ P 〈 0.05 ）. One casewas temporary recurrent laryngeal never injury and recovered in 4 months. Four cases were temporary hypoparathyroidism and no permanent hypoparathyroidism occurred. The tumor in 3 cases reoccurred locally in 0.5 - 3 years and was re - oper- ated. There was no death case. [ Conclusion] Metastasis of central group neck lymph node with papillary thyroid carcino- ma was higher than lateral group lymph node. Central group neck lymph node dissection should be performed routinely for clinical N1 patients. Central group neck lymph node dissection for clinical NO should be performed meanwhile initial surgi- cal treatment.