甲状腺乳头状癌中央区淋巴结清扫范围的合理选择

Reasonable Choice on Central Lymph Node Dissection for Papillary Thyroid Carcinoma

[目的]探讨不同情况下甲状腺乳头状癌中央区淋巴结清扫的合理术式。[方法]分析由同一组外科医生连续收治的符合要求的184例甲状腺乳头状癌患者的临床资料,全组患者均接受甲状腺双侧全切及全中央区(Ⅵ区)淋巴结清扫术。[结果]总体中央区淋巴结转移率为40.2%(74/184),单侧微小癌组与单侧非微小癌组对侧中央区淋巴结转移率分别为10.8%(9/83)和31.2%(15/48),单侧单灶与单侧多灶对侧中央区淋巴结转移率分别为16.8%(19/113)和27.8%(5/18),双侧多灶组双侧中央区淋巴结转移率为54.3%(25/46)。右侧微小癌组与右侧非微小癌组右喉返神经后淋巴结转移率分别为9.5%(4/42)和23.8%(5/21),左侧病灶右喉返神经后淋巴结转移率为4.4%(2/45),左侧非微小癌右喉返神经后淋巴结转移率为15.4%(2/13),未发现左侧微小癌出现右喉返神经后淋巴结转移。[结论]合理的中央区淋巴结清扫术式应为:对于多灶性癌、单侧非微小癌均应行全中央区淋巴结清扫;对于右侧微小癌应至少行右中央区喉返神经前淋巴结的清扫;对于左侧微小癌应至少行左中央区淋巴结清扫。

[Purpose] To investigate the central lymph node dissections of papillary thyroid carci- noma under different circumstances. [Methods] The clinical data of 184 cases with papillary thy- roid carcinoma were analyzed （all patients were under the treatment of the same group of surgeons in Thyroid Surgery）. All patients have undergone operation of bilateral total resection of thyroid gland and lymph node dissection. [ Results ] The over all metastasis rate of central lymph node was 40.2% （74/184）,which of minimum cancer patients and multifocal carcinoma patients were 10.8% （9/83） and 31.2%（15/48） respectively ,and which of unilateral single focus and unilateral multi- focus were 16.8% （19/113 ）and 27.8%（5/18）respectively. The metastasis of central lymph node of bilateral multi-focus was 54.3%（25/46）,the metastasis of micro-carcinoma and non-micro-carcino- ma of fight recurrent laryngeal nerve lymph nodes was 9.5%（4/42） and 23.8% （5/21）,the metasta- sis of right recurrent laryngeal nerve lymph nodes on left side was 4.4%（2~45）,the metastasis of non-micro-carcinoma of right recurrent laryngeal nerve lymph nodes on left side was 15.4%（2/13）. No patients with metastasis of micro-carcinoma of left recurrent laryngeal nerve lymph nodes was found. [Conclusions] Optimal central lymph node dissection （CLND） should be CLND for the pa- tients with multi-focus cancer and unilateral non minimal cancer; In patients with minimal cancer on the right,CLND should be performed from laryngeal nerve on right center to posterior branch- es; and the minimum cancer on the left side should be performed at least have left central lymph node dissection.