甲状腺乳头状癌喉返神经后方淋巴结清除的意义及方法

Lymph node metastasis posterior to recurrent laryngeal nerve in papillary thyroid cancer: observing from the central compartment lymph node dissection

目的:评估中央区淋巴结清除时,喉返神经后方食道旁淋巴结转移的发生率。方法 :报道178例甲状腺乳头状癌患者进行甲状腺全切除并行中央区淋巴结清除,分析中央区喉返神经后方淋巴结的转移情况。结果:178例患者中有23例表现出喉返神经后方淋巴结有转移,右侧喉返神经后方淋巴结转移率较高。右侧喉返神经后淋巴结转移和甲状腺癌直径>1 cm,腺体包膜外侵袭,多灶性甲状腺癌和同侧颈侧区淋巴结有转移时通常关系密切。结论:甲状腺乳头状癌有腺体包膜外侵袭,癌灶直径较大,甲状腺癌多发灶,颈侧区淋巴结有转移时应将中央区喉返神经后方的淋巴结一起清除。

Objective： To evaluate the metastatic rate of perioesophageal lymph nodes posterior to RLN during central compartment lymph node dissection. Method： This was a prospective observational study of 178 patients with papillary thyroid cancer （PTC） who underwent total thyroidectomy and central compartment lymph node dissection between January 2010 to June 2013. The lymph node metastasis posterior to RLN during central compartment lymph node dissection was analyzed. Results： Lymph node metastases posterior to RLN appeared in 23 out of the 178 pa tients, particularly in the right RNL. Lymph node metastases posterior to the right RLN are closely associated with larger primary tumors size（〉 1 cm diameter）, extrathyroid extension, multifocal thyroid cancers, and ipsilateral cervical lymph node metastasis. Conclusion： Lymph node posterior to recurrent laryngeal nerve（RLN） should be included in the central compartment dissection in patients with larger primary PTC, extrathyroid extension, multifocality, and cervical lymph node metastasis.