CN0期甲状腺乳头状癌颈淋巴结转移规律的探讨

Lymph node metastasis of CN0 papillary thyroid carcinoma

目的探讨CN0期甲状腺乳头状癌（papillary thyroid carcinoma，PTC）颈部淋巴结的转移规律及合理的手术方式。方法回顾性分析2008年2月至2011年2月吉林大学第一医院收治的450例CN。期PTC的临床资料。结果pN＋219例（48．67％），pN。231例（51．33％）。转移淋巴结的分布以Ⅵ区最常见，为46．22％（208／450）（单侧甲癌41．08％，双侧甲癌58．09％）；其次是Ⅱa、Ⅲ、Ⅳ区：分别为4．44％（20／450），6．00％（27／450），8．89％（40／450），Vb区较少淋巴结转移，为2．22％（10／450），而I区清扫2例均未见转移。当肿瘤直径≥1．0em、侵犯包膜或多灶性、男性、年龄〈45岁者，淋巴结转移发生率明显增加（P〈0．05）。另外，肿瘤位于甲状腺上极者，患侧33．57％（48／143）Ⅱa、Ⅲ、Ⅳ区淋巴结发生转移；肿瘤位于甲状腺下极，对侧Ⅵ区10．48％（13／124）发生转移。结论PTC最常发生Ⅵ区淋巴结转移，其次为Ⅱa、Ⅲ、Ⅳ区，建议初次手术常规清扫Ⅵ区淋巴结。当肿块直径≥1．0cm、肿瘤侵犯甲状腺包膜或Ⅵ区淋巴结转移超过3枚以上时，应适当扩大淋巴结清扫的范围（1Ⅱa～Ⅳ区）。肿瘤位于甲状腺下极时，建议清扫对侧Ⅵ区淋巴结；位于甲状腺上极时，建议清扫患侧Ⅱa、Ⅲ、Ⅳ区的淋巴结。

Objective To discuss the metastasis principle of cervical lymph nodes in CN0 papillary thy- roid carcinoma（PTC）and to define the proper surgery scope. Methods Clinical data of the 450 cases of CN0 PTC patients undergoing surgery from Feb. 2008 to Feb. 2011 in the First Hospital, Jilin University were retro- spectively analyzed. Results There were 219（48.67% ）pN＋ eases and 231 （51.33%）pN0 cases. In CNoPTC cases, lymph node metastasis was most commonly detected in areaVI, about 46. 22% （208/450） （unilateral canc- er 41.08%, bilateral cancer 58.09% ）. The lymph node metastasis rate was 4. 44% （20/450）, 6.00% （27/ 450）, and 8.89% （40/450）respectively in area IIa, area III, and area IV. The metastasis of lymph node was rare in Vb area, only about 2. 22 % （10/450）. No metastasis was found in the 2 cases undergoing area I lymph node dissection. When the tumor diameter was no less than 1.0 cm, capsule invaded or muhifocal, male, 〈 45 years old, lymph node metastasis rate was significantly increased （ P 〈 0. 05 ）. In addition, when the tumor was located at the upper pole of the thyroid, the lymph node metastasis rate was 33.57% （48/143）in Ⅱa、Ⅲ、Ⅳ are- as in the affected side. When the tumor was at the lower pole of the thyroid, the lymph node metastasis rate was 10. 48% （13/124）in the contralateral area VI. Conclusion Lymph node metastasis oceurs most commonly in area VI in PTC, followed by area Ⅱa, area Ⅲ, area Ⅳ. Routine lymph node dissection in area VI is recommen- ded for the initial surgery. When the tumor diameter is I〉 1.0 cm, thyroid capsule invasion is involved or more than 3 metastasized lymph nodes were found in area VI, the range of lymph node dissection should properly be ex- panded to area Ⅱa -Ⅳ. When the tumor is located at the lower pole of the thyroid, area VI in the contralateral side should be cleaned. If the tumor is located at the upper pole of the thyroid, area Ⅱa、Ⅲ、Ⅳ in the affeeted side should be cleaned.