cN_0甲状腺微小乳头状癌淋巴结转移高危因素及行预防性清扫临床分析

Clinical analysis for 57 re-operational cases of differentiated thyroid cancer

目的探讨影响cN0甲状腺微小乳头状癌淋巴结转移高危因素及行预防性清扫的意义及可行性。方法回顾性分析济南军区总医院2008年2月至2012年9月术前诊断为cN0甲状腺微小乳头状癌行甲状腺全切并双侧中央区淋巴结及患侧Ⅲ、Ⅴ区(+)Ⅱ区淋巴结清扫162例的临床资料,统计年龄、性别、肿物大小、有无侵及甲状腺被膜情况、原发灶数目、肿瘤单双侧、颈部淋巴结转移、手术并发症,探讨临床特征与颈部淋巴结转移关系。结果 162例患者中74例(45.7%)患者发生颈部淋巴结转移,71例中央区淋巴结转移阳性,转移率为43.8%,45例颈侧区(Ⅲ、Ⅴ区(+)Ⅱ区)淋巴结转移阳性,转移率为29.6%。年龄、肿瘤有无浸润包膜是PTMC颈部淋巴结转移的危险因素。术后并发喉返神经麻痹发生率为0.62%(1/162),系肿瘤侵犯喉返神经切断喉返神经所致,其中1例(0.62%)术后颈部切口出血,行手术止血,2例(1.23%)皮下淤血,保守治疗治愈。2例(1.23%)术后乳糜漏,均为左侧清扫患者,行持续负压吸引、左颈静脉角局部加压包扎治疗后治愈。59例(36.4%)患者术后出现低钙血症,血甲状旁腺PTH低于参考值下限,治疗后恢复正常。无永久性甲状旁腺损伤并发症发生。结论对cN0PTMC行甲状腺全切并双侧中央区淋巴结清扫,高危患者行患侧Ⅲ、Ⅴ区(+)Ⅱ区淋巴结清扫具有重要意义并安全可行。

Objective To explore factors influencing the metastasis of lymph nodes in clinical analysis negative （ cN0 ） papillary thyroid microcarcinoma and to analyze the value and feasibility of total thyroidectomy and prophylactic lymph node cleaning in Ⅶ） Ⅵ, Ⅲ and Ⅳ（ ＋ ） Ⅱ. Methods The clinical statistics of 162 patients with cN0 papillary thyroid microcarcinoma treated by total thyroidectomy and prophylactic lymph node cleaning in Ⅵ, Ⅲ and Ⅳ（ ＋ ） Ⅱ in Jinan Military General Hospital from November 2008 to March 2012 were systemically retrospectively analyzed. Results Of the 162 cases, 74 cases（74/162,45.7% ） were positive in lymph node in which 71 cases（71/162,43.8% ） happed in central line and 45 cases （45/ 162,29.6% ） in lateral line Ⅲ and Ⅳ（ ＋ ） Ⅱ. The relative risk factors of neck lymph node metastasis in PTMC reside in age and invasion state of tumor capsule. There was only one single laryngeal recur- rent nerve injury for tumor invasion. There was 1 case of breeding（0.62% ）, 2 hematoma（ 1.23% ） and 59 temporary parathyroid function decline. All were cured after treatment. No permanent parathyroid gland damage happened. Conclusion It is safe and of great important and operable probability to do the total thyroidectomy and VI neck lymph node cleaning （ high risk including Ⅲ and Ⅳ（ ＋ ） Ⅱ ） for cN0 PTMC.