甲状腺乳头状癌中央区食道旁淋巴结清扫的临床意义

Clinical Significance of Lymph Node Dissection in Central Paraesophageal Region in Treatment of Thyroid Papillary Carcinoma

目的探讨中央区淋巴结清扫在甲状腺乳头状癌治疗中的临床意义.方法选取128例甲状腺乳头状癌行同侧中央区淋巴结清扫的患者作为观察对象,按照手术方式将其分为健康观察组(65例,行单侧或双侧甲状腺腺叶+峡部切除+中央区淋巴结清扫术)与对照组(63例,行单侧或双侧甲状腺腺叶+峡部切除术),随访2 a,对比两组患者的中央区食道旁淋巴结转移、外侧区淋巴结转移、复发及并发症情况.结果 1)随访期间,两组均未出现死亡病例;观察组随访期内发生中央区淋巴结转移5例,转移率为7.69%;颈侧区淋巴结转移3例,转移率为4.62%;对照组随访期内发生中央区淋巴结转移11例,转移率为17.46%;颈侧区淋巴结转移7例,转移率为11.11%;对照组明显高于观察组,两组比较具有统计学意义(P<0.05).2)观察组术后并发症发生率为13.85%,对照组术后并发症发生率为15.38%,两组之间比较无统计学意义(P>0.05).结论甲状腺乳头状癌的中央区淋巴结转移率较高,行中央区食道旁淋巴结清扫治疗术后复发率与并发症发生均较低,值得在临床中推广应用.

Objective To explore the clinical significance of central lymph node dissection in the treatment of papillary thyroid carcinoma. Method A total of 128 patients with thyroid papillary carcinoma who underwent lymph node dissection in the ipsilateral central region were selected as the research object. The patients were divided into the observation group （65 cases,underwent unilateral or bilateral thyroid lobectomy and isthmectomy＋ central lymph node dissection ） and the control group （ 63 cases, underwent unilateral or bilateral thyroid lobectomy and isthmectomy） . The metastasis of paraesophageal and lateral lymph nodes,incidence of postoperative recurrence and complications were compared between the two groups after 2-year follow-up. Results 1）During the follow-up period,there was no death case appeared in two groups. In the observation group,there were 5 cases of central lymph node metastasis with the metastatic rate of 7 . 69%, and 3 cases of with the metastatic rate of 4. 62%. In the control group,there were 11 cases of central lymph node metastasis with the rate of 17. 46%,and 7 cases of lateral neck lymph node metastasis with the rate of 11. 11%. The lymph node metastatic rates of the control group were significantly higher than that of the observation group （P〈0. 05）. 2） In the observation group, the complications rate was 13. 85%. In the control group,the incidence rate of complications was 15. 38% . There was not statistically significant between the two groups （P〉0. 05）. Conclusion The metastatic rate of central lymph node in the patients with thyroid papillary carcinoma is very higher. And the rates of postoperative recurrence and complications decreased after lymph node dissection in the central paraesophageal region. Therefore, this treatment method is worth to be extended clinically.