预防性中央区淋巴结清扫在颈淋巴结阴性分化型甲状腺癌手术中的应用效果评价

Clinical application of preventive central lymph node dissection in differentiated thyroid carcinoma with negative neck lymph node

目的观察预防性中央区淋巴结清扫在颈淋巴结阴性(cN0期)分化型甲状腺癌(DTC)患者手术中的应用效果。方法选取2008年5月—2011年12月本院收治的cN0期DTC患者255例,并按随机数字表分成A组(n=129)和B组(n=126)。A组采取预防性中央区淋巴结清扫,B组未行预防性中央区淋巴结清扫。记录术后并发症、局部转移、再次手术率。结果 A组出现声音嘶哑2例(1.6%),暂时性低钙7例(5.4%),随访3年内无局部复发与再次手术病例;B组术后声音嘶哑3例(2.4%),暂时性低钙抽搐6例(4.8%),随访3年内出现同侧淋巴结转移7例(5.6%),在本院行再次手术。结论预防性中央区淋巴结清扫治疗cN0期DTC患者安全有效,可明显减少因转移导致的再次手术率。

Objective To investigate the clinical application of preventive central lymph node dissection in differentiated thyroid carcinoma（DTC） with cervical lymph node negative（cN0 stage）.Methods A total of 255 DTC patients at cN0 stage from May 2008 to December 2012 in our department were divided into group A（n=129） and group B（n=126） according to the random number table.Group A was administered the prophylactic central lymph node dissection and group B did not undergo prophylactic central lymph node dissection.The postoperative complications and partially transferred to the incidence of reoperation were observed and recorded.Results There were 2 cases of hoarseness and 7 cases of transient hypocalcemia in group A.There was no local recurrence and no reoperation cases about 3-year follow-up in group A.There were 3 cases of hoarseness and 6 cases of transient hypocalcemia in group B.There were 7 cases with lymph node-positive in Ⅵ district recurred carcinoma about 3-year follow-up in group B.There were 7 cases of reoperation in our hospital.Conclusion Central lymph node metastasis is safe and effective in treating patients with DTC at cN0 stage,and it can remarkably reduce the reoperation caused by transfer.