颈淋巴结清扫在分化型甲状腺癌手术中的应用价值

The clinical value of selective neck dissection for differentiated thyroid carcinoma

目的探讨颈部淋巴结清扫在分化型甲状腺癌手术中应用的合理性及必要性。方法回顾性分析我院自2013-01~2013-05收治的110例首次治疗的分化型甲状腺癌患者的临床及术后资料。结果本组110例患者临床淋巴结阴性（c N0）86例,临床淋巴结阳性（非c N0）24例。所有患者均行患侧颈Ⅵ区淋巴结清扫,18例非c N0患者行颈侧选择性淋巴结清扫。110例患者Ⅵ区淋巴结总转移率为47.27%（52/110）,c N0患者Ⅵ区淋巴结转移率为44.19%（38/86）,非c N0患者Ⅵ区淋巴结转移率为58.33%（18/24）,18例非c N0患者颈侧淋巴结转移率为100%（18/18）。本组无严重并发症发生。结论分化型甲状腺癌具有较高的颈Ⅵ区淋巴结转移率,患侧颈Ⅵ区淋巴结预防性清扫应作为甲状腺癌的常规手术方式。对于术前临床淋巴结阳性的患者应常规行选择性颈侧淋巴结清扫,从而为甲状腺癌的术后疗效提供更确切的保障。

Objective To discuss the reasonability and necessity of neck lymph node dissection for differentiated thyroid carcinoma（ DTC）. Methods The clinical data and the follow-up data of 110 patients with papillary thyroid carcinoma（ PTC） first treated in the First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to May 2013 were retrospectively analyzed. Results Of110 cases,86 were clinical lymph node negative（ c N0）,and 24 cases were clinical lymph node positive（ non-c N0）. All these patients performed central lymph node dissection in district Ⅵ of the affected side,and 18 non-c N0 patients performed selective lateral neck lymph node dissection. The total rate of lymph node metastasis in district Ⅵ was 47. 27%（ 52 /110）,and it was 44. 19%（ 38 /86）,58. 33%（ 18 /24） for the c N0 and non-c N0 patients,respectively. The lateral neck lymph node metastasis rate was 100%（ 18 /18） for the nonc N0 cases. No severe complication occurred. Conclusion DTC has high metastasis rate in the district Ⅵ. So it is necessary to clean lymph nodes in the district Ⅵ routinely and take a selective lateral neck lymph node dissection for clinical lymph node positive cases,which provide more accurate guarantee for the postoperative efficacy of thyroid carcinoma.