中央区淋巴结清扫在Ⅰ期甲状腺乳头状癌治疗中的作用

Significance of lymph node dissection in central neck region in treatment of stage Ⅰ papillary thyroid carcinoma

目的探讨中央区淋巴结清扫治疗I期甲状腺乳头状癌的临床意义。方法回顾性分析1998～2006年收治的46例甲状腺乳头状癌行中央区淋巴结清扫的临床资料,探讨中央区淋巴结转移率及行中央区淋巴结清扫术后复发再手术率和并发症发生率。结果该组中央区淋巴结转移22例,转移率47.8%。术后并发症共4例,发生率8.7%。术后并发暂时性喉返神经麻痹1例,甲状旁腺功能减退2例,治疗后恢复正常,乳糜瘘1例,加压包扎1周后痊愈。术后1年出现颈侧区淋巴结转移2例,均行选择性颈侧区清扫,无一例损伤喉返神经,复发再手术率4.3%。结论 I期甲状腺乳头状癌中央区淋巴结转移率高,首次手术有必要行中央区清扫,可降低复发再手术率且并发症少。

Objective】To study the clinical significance of dissection of lymph node in central neck region in the treatment of stage I papillary thyroid carcinoma.【Methods】The clinical data were analyzed retrospectively of 46 cases with papillary thyroid carcinoma undergoing dissection of lymph node who were admitted from 1998 to 2006 in order to study the metastasis rate of lymph node in central neck region,the re-operation rate after recurrence following dissection of lymph node,complication incidence.【Results】22 cases suffered from metastasis of lymph nodes in central neck region accounted for 47.8%.4 cases from post-operation complications and the incidence rate was 8.7%,1 case from temporary recurrent nerve paralysis,2 cases from hypoparathyroidism（recovered to normal after treatment）,1 case from chylous fistula（recovered one week after pressure dressing）.1 year after operation 2 cases suffered from metastasis of lymph node to lateral neck region.They underwent elective lateral dissection without damaging recurrent laryngeal nerve and the re-operation rate was 4.3%.【Conclusions】Metastasis rate of lymph node in central neck region for stage Ⅰ papillary thyroid carcinoma is high and it is desirable to implement dissection of lymph nodes in central neck region with the purpose of cutting re-operation rate after recurrence and with the benefits of low incidence of complications.