经颈前弧形切口行3 4区淋巴结清扫对降低甲状腺乳头状癌术后颈部淋巴结转移的意义

目的：探讨甲状腺乳头状癌淋巴结转移的临床特点及侧颈区淋巴结清扫方法和临床意义。方法回顾性分析2010年1月至2014年12月接受手术治疗的甲状腺乳头状癌的临床资料。结果从胸锁乳突肌内侧入路行3、4区淋巴结淋巴结切除术，术中不需延长手术切口，术后未增加相关并发症。减少术后侧颈淋巴结转移的发病率，降低二次手术的发病率。结论对于临床分期Ⅰ期乳头状甲状腺癌，术前检查未见肿大淋巴结的首次手术患者，经颈部小切口行3、4区淋巴结清扫，可以作为替代根治性或改良性颈清扫的一种选择。

Objective To analyze the clinical characteristics of lymph node metastasis on papillary thyroid carcinoma,to explain the approach of and to evaluate the clinical influence of the selective lymph node dissection in lateral neck Methods It analyzes the clinical cases of papillary thyroid carcinoma between 2010 to 2015 in Breast and Thyroid Department of Nanjing First Hospital. Results If surgeons perform level III and level IV lymph node dissection through inner sternocleido mastoid muscle,incision does not have to be extended,patients do not develop complications after the surgery,lymph node metastasis rate in the posterior neck is reduced and relapse is prevented largely. Conclusion For patients who are diagnosed the first（I）stage of papillary thyroid carcinoma,if they have no enlargement of lymph nodes before surgery and if it is their first time having the surgery,they can accept level III and level IV lymph node dissection through a small incision in neck as a substitute for modified or radical neck dissection.