甲状腺乳头状癌咽旁淋巴结转移13例分析

Surgical treatment of parapharyngeal lymph node metastasis arising from papillary thyroid carcinoma:A report of 13 patients

目的探讨甲状腺乳头状癌咽旁淋巴结转移的临床特点及治疗方法。方法回顾性分析2002-01-01至2013-12-31复旦大学附属肿瘤医院头颈外科收治的13例甲状腺乳头状癌咽旁淋巴结转移病人的临床资料。结果咽旁病灶行颈侧颌下入路的咽旁淋巴结切除术。术后无咽旁相关并发症。9例病人颈部淋巴结广泛转移。5年总存活率和无瘤存活率分别为77.7%和55.5%,2例死于肺转移。咽旁间隙局部无复发。结论颈部淋巴结广泛转移的病人可能出现咽旁淋巴结转移。CT或MRI有助于术前诊断。手术切除是其主要治疗手段。咽旁淋巴结转移的病人病期较晚,侵袭性强,易于远处转移,但通过积极治疗,预后仍然较好。

Objective To investigate the clinical features and therapy associated with parapharyngeal lymph node metastasis arising from papillary thyroid carcinoma. Methods The clinical data of 13 patients with parapharyngeal lymph node metastasis arising from papillary thyroid carcinoma admitted between January 1, 2002 and December 31, 2013 in Department of Head and Neck, Fudan University Shanghai Cancer Center were analyzed retrospectively. Results All patients were performed parapharyngeal lymphadenectomy via the transcervical submandibular approach. No surgery-associated complications were noted. Nine patients had widespread metastases to cervical lymph nodes. The 5 year overall survival rate and disease-free survival rate was 77.7% and 55.5% respectively. Two patients died of lung metastases. No local recurrence occurred at parapharyngeal space. Conclusion Parapharyngeal lymph node metastasis from PTC may occur in patients with previous neck dissection. CT or MRI is helpful for diagnosis. Surgical resection remains the main treatment method. Parapharyngeal lymph node metastasis is associated with advanced disease stage, high invasive and distant metastases capability, but the prognosis is still good after the active treatment.