cN0甲状腺乳头状微小癌预防性中央区淋巴结清扫的探讨

Explore of prophylactic central compartment lymph node dissection in cN0 papillary thyroid microcarcinoma

目的探讨预防性中央区淋巴结清扫在cN0甲状腺乳头状微小癌手术中的必要性及预防性淋巴结清扫的范围。方法对本院2009~2014年收治的63例cN0甲状腺乳头状微小癌患者行患侧预防性中央区淋巴结清扫术,标本常规送病理检查。结果中央区淋巴结转移率为33.33%,气管-食管沟淋巴结转移率明显高于喉前及气管前淋巴结,且喉返神经内侧的气管-食管沟淋巴结转移率明显高于喉返神经外侧的气管-食管沟淋巴结。预防性中央区淋巴结清扫并不扩大手术切口,不增加手术并发症。结论 cN0甲状腺乳头状微小癌行预防性中央区淋巴结清扫是必要、安全、可行的。中央区淋巴结清扫的范围主要是气管-食管沟淋巴结,特别是喉返神经内侧的气管-食管沟淋巴结。

Objective To explore the necessity of prophylactic central compartment lymph node dissection in cN0 papillary thyroid microcarcinoma（ PTMC） and to explore the lymph node dissection scope of central compartment.Methods Sixty-three patients with cN0 PTMC who had undergone central compartment lymph node dissection during2009 to 2014 were enrolled in this study. The specimens were sent for routine histopathological examination. Results The central compartment lymph node dissection was found in 21 of the 63 patients and the metastasis rate of central compartment lymph node was 33. 33%. The metastasis rate of tracheoesophageal area lymph node was higher than that of the pre-laryngeal and pre-trachea. Lymph node metastasis rate inside laryngeal recurrent nerve was higher than outside laryngeal recurrent nerve. Prophylactic central compartment lymph node dissection did not expand the incision or increase the surgical complications. Conclusions It is necessary,safe and operational for prophylactic central compartment mainly include the lymph node dissection in cN0 PTMC. The lymph node dissection scope of central compartment was tracheoesophageal area,especially the lymph node inside the laryngeal recurrent nerve.