不同病灶甲状腺微小乳头状癌淋巴结转移分析

目的分析中央区淋巴结清扫术在甲状腺微小乳头状癌手术中尤其是多灶性患者中的必要性。方法回顾性分析174例甲状腺微小乳头状癌的临床资料。结果174例甲状腺微小乳头状癌患者均行不同形式手术。单灶性与多灶性患者分别1284例、46例，颈部淋巴结转移率分别29．7％、52．2％，侵犯甲状腺包膜发生率分别为9．4％、21．7％。多灶性患者较单灶性患者更容易出现颈淋巴结转移（x^2=8．26，P〈0．05），多灶性患者较单灶性患者更容易出现侵犯甲状腺包膜（X^2=4．68，P〈0．05）。结论多灶性甲状腺微小乳头状癌淋巴结转移率及侵犯甲状腺包膜发生率较高，手术应常规中央区淋巴结清扫术，单灶性甲状腺微小癌患者也建议行中央区淋巴结清扫术。

Objective To discuss the necessity of lymph node dissection of central group in the patients with papillary thyroid microcarcinoma （ PTMC ） especially multifocal PTMC patients. Methods 174 cases with PTMC were retrospectively reviewed in the second hospital of Shaoxing. Results 174 cases with PTMC underwent different forms of surgery.Of 128 patients with solitary PTMC and of 46 patients with multifocal PTMC, the neck lymph node metastasis rate was 29.7%, 52.2%, the violation of thyroid capsule rate was 9.4%, 21.7%. There was significance of cervical lymph node metastasis and violation of thyroid capsule between solitary PTMC group and multifocal PTMC group. Conclusion The neck lymph node metastasis rate and the violation of thyroid capsule rate were much higher in multifocal PTMC patients, the lymph node dissection of central group should be performed routinely for multifocal PTMC patients, and should also be advised for solitary PTMC patients.