中央区淋巴结清扫术在治疗甲状腺乳头状癌的意义

Central neck dissection for the treatment of papillary thyroid carcinoma

目的探讨中央区淋巴结清扫术在甲状腺乳头状癌中的应用价值。方法回顾性分析我院192例初次诊治且术前无任何局部并发症的甲状腺乳头状癌患者临床病理资料。结果本组患者总体颈部淋巴结转移率为52.1%,中央区淋巴结转移率为50.0%。微小癌组与非微小癌组颈部淋巴结转移率分别为44.1%、66.7%,中央区淋巴结转移率分别为43.3%、63.1%。微小癌组与非微小癌组淋巴结转移发生率有明显差异(χ2=9.593,P<0.05)。微小癌组中,原发灶大小对淋巴结转移率无明显影响(χ2=0.982,P>0.05),多发灶患者较单发灶者更容易出现颈淋巴结转移(χ2=4.334,P<0.05)。结论非微小甲状腺乳头状癌应常规进行中央区淋巴结清扫术,微小甲状腺癌也应建议中央区淋巴结清扫术。

Objective To discuss the application value of central group neck lymph node dissection in the patients with papillary thyroid carcinoma （PTC）. Methods 192 cases with PTC were retrospectively reviewed. All the patients without any complications preoperative were first diagnosed and treated in our hospital. Results The rate of cervical lymphatic metastasis was 52.1% overall, while the rate of central group lymph node metastasis was 50.0%. The rate of cervical lymphatic metastasis in the group of papillary thyroid microcarcinoma （PTMC） and the group of Non-PTMC were 44.1%and 66.7%respectively, while the rate of central group lymph node metastasis were 43.3% and 63.1% respectively. There was significance of cervical lymph node metastasis between the group of PTMC and the group of Non-PTMC. The tumor size had no effect on lymphatic metastasis in the group of PTMC. There was significance of cervical lymph node metastasis between solitary PTMC group and multifocal PTMC group. Conclusion The central neck dissection should be performed routinely for Non-PTMC patients, and should also be advised for PTMC patients.