5mm以下甲状腺乳头状癌需否中央区淋巴结清扫探讨

目的探讨直径5mm以下的甲状腺微小乳头状癌（PTMC）需否行中央区淋巴结清扫术。方法回顾性分析178例5mm以下PTMC患者资料。所有患者均接受中央区淋巴结清扫或改良选择性颈淋巴结清扫术。结果178例患者中50例有中央区颈淋巴结转移，其中4例同时伴侧颈部淋巴结转移；甲状腺包膜侵犯的患者淋巴结转移率显著高于包膜未侵犯者，年龄、性别、多灶性、合并桥本病等临床因素和淋巴结转移无明显关系。结论肿瘤侵犯包膜与5mm以下PTMC患者中央区淋巴结转移密切相关，预防性中央区淋巴结清扫术有一定意义。

Objective To analyze the necessity of central lymph node （CLN） dissection for papillary thyroid microcarcinoma（PTMC）which is less than 5mm. Method The clinical data of 178 patients with PTMC were analyzed retrospectively. All the patients underwent central neck dissection or modified selective lateral neck dissection. Neck lymph node metastasis rate was calculated. Some clinical factors were compared between patients with or without lymph node metastasis. Result 50 patients were found with central lymph node metastasis, and 4 patients were detected with lateral neck node metastasis. The neck lymph node metastasis rate of the patient with thyroid capsule invasion was significantly higher than that without capsule invasion. Age,sex,multifocality, companied with lymphocytic thyroditis were not significantly correlated with central lymph node metastasis. Conclusion Thyroid capsule invasion is associated with central lymph node metastasis of patients with PTMC less than 5mm. Prophylactic central neck dissection are not unnecessary.