甲状腺乳头状癌淋巴结转移特点分析及术式探讨

Analyiss of lymph nodes metastasis in papillary thyroid carcinoma and its surgical approaches

目的 分析研究甲状腺乳头状癌淋巴结转移的特点及手术方式.方法 总结分析2011年12月至2012年12月在吉林大学第一医院甲状腺外科实施甲状腺癌根治术同时行中央区及侧颈区淋巴结清扫的123例甲状腺乳头状癌的临床资料.结果 随着中央区阳性淋巴结个数的增加,侧颈区淋巴结转移阳性率及多区转移的比例呈明显上升趋势.102例侧颈淋巴结阳性的患者中,Ⅱ区阳性55例（53.92％）,Ⅲ区阳性62例（60.78％）,Ⅳ区阳性76例（74.51％）,Ⅴ区阳性17例（16.67％）.在侧颈转移过程中,Ⅳ区为最易受侵犯的区域,其次为Ⅲ区,再次为Ⅱ区,最后为Ⅴ区.结论 甲状腺乳头状癌患者首次治疗中常规行预防性中央区淋巴结清扫,中央区淋巴结转移阳性特别是阳性淋巴结较多（＞3）患者应同时行患侧Ⅱ～Ⅴ区淋巴结清扫.

Objective To investigate the characteristics of lymph nodes metastasis in papillary thyroid carcinoma （PTC） and to discuss surgical approach.Methods All patients underwent total thyroidectomy,central lymph nodes and lateral lymph nodes dissection in Department of Thyroid Surgery,the First Hospital of the Jilin University,from Dec.2011 to Dec.2012.Results With the increase of the number of positive central lymph nodes,lateral cervical lymph node metastasis rate increased as well and accompanied multi region metastasis trend.In 102 cases of lateral positive cervical lymph node patients,55 cases were in level Ⅱ,accounting for 53.92％,62 cases were in level Ⅲ,accounting for 60.78％,76 cases were in level Ⅳ,accounting for 74.51％,and 17 cases were in level V,accounting for 16.67％.In lateral lymph nodes metastasis,we found level Ⅳ was the most vulnerable area,followed by level Ⅲ,level Ⅱ and level Ⅴ.Conclusions Prophylactic central lymph node dissection should be performed in PTC patients.Patients with central lymph node metastasis especially with the number of positive lymph nodes ＞ 3 should be performed ipsilateral level Ⅱ-Ⅴ lymph node dissection.