颈内静脉旁淋巴结活检在甲状腺癌手术中的应用

Biopsy of lymph nodes alongside of the internal jugular vein in surgery for thyroid cancer

目的:探讨分化型甲状腺癌(DTC)颈内静脉旁淋巴转移的特点,以及手术治疗中颈内静脉旁淋巴结活检的意义。方法:回顾性分析2006年1月―2012年6月间根治术中行颈内静脉旁淋巴结活检的98例(106侧)DTC患者临床病理资料。根据术前临床体检和影像学检查结果分为临床颈侧区淋巴结转移阳性(cN1b)和阴性(cN0)两组,分别与术后病理结果作比较。结果:106侧颈内静脉旁淋巴结活检阳性者46侧(43.4%),其中cN1b组56侧阳性者39侧(69.6%),cN0组50侧阳性者7侧(14.0%);假阳性率28.3%(17/60),假阴性率15.2%(7/46)。结论:DTC颈内静脉旁淋巴结转移常见;术前判断有无颈侧区淋巴结转移存在不足,建议在DTC根治术中常规行颈内静脉旁淋巴结活检。

Objective： To investigate the features of metastasis in the lymph nodes alongside of the internal jugular vein（IJV） in di erentiated thyroid cancer（DTC） and the signi cance of biopsy of lymph nodes around the IJV during surgery.Methods： e clinical and pathological data of 98 DTC patients（106 cervical sides） undergoing biopsy of the lymph nodes alongside of the IJV in radical thyroidectomy from January 2006 to June 2012 were reviewed.Patients were divided into lymph node metastasis（cN1b） group and lymph node negative（cN0） group according to the preoperative physical and imaging ndings,and the data between preoperative examinations and postoperative pathological results were compared.Results： Forty-six（43.4%） of the 106 cervical sides of the lymph nodes alongside of the IJV after biopsywere positive,which included 39 of the 56 sides in cN 1b group and 7 of the 50 sides in cN 0 group.So,the false positive and negative rates were 28.3%（17/60） and 15.2%（7/46）,respectively.Conclusion： DTC frequently metastasizes to the lymph nodes alongside of the IJV.Decision based on preoperative examinations is insuicient to identify whether the lateral neck lymph nodes are involved,so the routine biopsy of lymph nodes alongside of the IJV during radical surgery for DTC is recommended.