颈淋巴结清扫术在CN0期甲状腺乳头状癌中的应用价值

Application value of cervical lymph node dissection on Papillary Thyroid Cancer in CN0

目的探讨颈淋巴结清扫术在CN0期甲状腺乳头状癌中的应用价值。方法回顾性分析2012年2月至2014年2月在吉林大学第一医院接受首次手术治疗并经病理证实的121例CN0期甲状腺乳头状癌患者的临床与病理资料。结果 1121例CN0期甲状腺乳头状癌患者的颈淋巴结转移率为45.45%(55/121),其中以Ⅵ区淋巴结转移率最高,约为43.80%(53/121),侧颈区(Ⅱ、Ⅲ、Ⅳ区)淋巴结转移率为13.22%(16/121)。2Ⅵ区与侧颈区淋巴结转移率比较,差异有统计学意义(P<0.05),且二者显著相关(相关系数r=0.344)。3侧颈区(Ⅱ、Ⅲ、Ⅳ区)淋巴结转移以Ⅳ区较常见,约为9.92%,侧颈各区间转移率差异有统计学意义(P<0.05)。结论甲状腺乳头状癌易发生颈淋巴结转移,以Ⅵ区最为常见,对于CN0期甲状腺乳头状癌的患者,建议初次手术常规清扫Ⅵ区淋巴结,并根据Ⅵ区淋巴结转移情况预防性清扫侧颈区淋巴结。

Objective To discuss the application value of cervical lymph node dissection on papillary thyroid cancer in CN0. Methods Clinical data of the 121 cases CN0 PTC patients who underwent surgery and were pathological diag- nosed as progressive multifocal PTC from February 2012 to February 2014 in the First Hospital,Jilin University were retrospectively analyzed. Results ①The lymph node metastasis rate was 45.45% in 121 cases CN0 PTC,among them ,the highest metastasis rate was 43.80%（53/121） in region VI and 13.22%（16/121） in region Ⅱ-Ⅳ. ②The difference of metastasis rate between region Ⅵ and region Ⅱ-Ⅳ was statistically significant（P〈0.05）, and they were significant ly correlated （correlation coefficient）. ③The region Ⅱ-Ⅳ lymph node metastasis were most commonly detected in the level of region Ⅳ and the difference of metastasis rate between region Ⅱ-Ⅳ was statistically significant（P〈0.05）. Conclusion PTC is prone to cervical lymph node metastasis,it is most common in region VI. We suggest that the Ⅵ area lymph nodes should be cleaned regularly when it was the initial surgery for CN0 PTC. According to the lymph node metastasis preventive cleaning region Ⅱ-Ⅳ lymph node.