甲状腺乳头状癌颈部Ⅱb区淋巴结转移特点及相关因素分析

Pattern of level Ⅱb lymph nodes metastasis with papillary thyroid carcinoma and clinical analysis

目的探讨甲状腺乳头状癌颈部Ⅱb区淋巴结转移规律及相关因素分析。方法回顾性分析2006年1月至2013年1月在广西医科大学附属肿瘤医院接受患侧同期颈淋巴结清扫术的甲状腺乳头状癌患者的临床资料,共纳入能够获得Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移情况的病人资料共61例,其中3例为双侧甲状腺乳头状癌伴双侧颈部淋巴结转移,共计算64侧颈各区淋巴结转移率,并分析各个临床指标,包括性别、年龄、T分期、颈部各区淋巴结转移率等与Ⅱb区转移的相关性。结果 61例病人,共64侧颈Ⅱ、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移率分别为34.4%(22/64)、43.8%(28/64)、42.2%(27/64)、25.0%(16/64)和48.4%(31/64),其中Ⅱa和Ⅱb区淋巴结转移率分别是25.0%(16/64)和9.4%(6/64)。多因素分析显示Ⅱa区淋巴结转移是Ⅱb区淋巴结转移的独立危险因素。结论甲状腺乳头状癌颈部Ⅱb区淋巴结转移率较低,如果出现Ⅱa区淋巴结转移则Ⅱb区应行常规清扫。

Objective To assess the pattern of level Ⅱb lymphatic metastasis in patients with papillary thyroid carcinoma （PTC） and its risk factors. Methods We retrospectively reviewed the clinical data of patients with PTC who underwent therapeutic later neck dissections in Affiliated Tumor Hospital of Guangxi Medical University between January, 2006 and January, 2013. Altogether 61 patients with PTC were included in the present study, whose pathological materials of lymphatic metastasis of level Ⅱ a, Ⅱ b, Ⅲ, Ⅳ, Ⅴ and Ⅵ were available . Among these cases, 3 patients had bilateral papillary thyroid carcinoma （BPTC） with bilateral neck lymphatic metastasis and received bilateral neck dissection. Altogether 64 neck lymphatic metastasis cases from 61 cases in our study were included for analysis. Results About 34.4%（22/64）, 43.8% （28/64）, 42.2%（27/64）, 25.0%（16/64） and 48.4%（31/64） of levels Ⅱ , Ⅲ, Ⅳ, Ⅴ, and Ⅵ lymphatic metastasis, respectively, were observed in the neck lymphatic metastasis of patients. Metastases in level Ⅱ a and Ⅱb were 25.0% （16/64） and 9.4%（6/64）, respectively. Conclusion Lymphatic metastasis may not be common in level Ⅱb in PTC patients, Level Ⅱ b lymphadenectomy may be considered when level Ⅱ a lymphatic metastasis is confirmed.