甲状腺乳头状微小癌中央区淋巴结清扫319例临床分析

Clinical Analysis of 319 Cases with Central Lymph Node Dissection in Treatment of Papillary Thyroid Microcarcinoma

目的:探讨甲状腺乳头状微小癌中央区淋巴结不同手术方式的意义。方法:回顾性分析2011年9月至2014年12月间接受手术的甲状腺乳头状微小癌319例患者临床资料。按手术切除淋巴结范围不同,分为A组:98例,行甲状腺全切除+同侧中央区淋巴结清扫术;B组:187例,行甲状腺全切除+双侧中央区淋巴结清扫术;C组:34例,仅行甲状腺全切除或近全切除术。比较不同组间患者术后并发症发生率以及复发/转移的差异。结果:永久性声带麻痹和甲状旁腺功能低下在B组的发生率分别为1.1%、1.6%,在A组和C组均为0。暂时性声带麻痹的发生率A组、B组分别为7.1%、8.0%,比C组的2.9%要高。暂时性低钙的发生率A、B、C组分别为18.4%、34.2%和5.9%。各组随访期内无死亡病例,A组出现颈侧区淋巴结转移1例,B组出现颈侧区淋巴结转移3例,肺转移1例,C组无复发/转移病例。结论:手术清扫的范围越大,术后并发症的发生率就越高,尤其是暂时性甲状旁腺功能低下。预防性淋巴结清扫手术可以结合患者癌灶的临床病理特征选择单侧或者双侧中央区淋巴结清扫术。

Objective:To explore a suitable range of central lymph node dissection for patients with papillary thyroid microcarcinoma.Methods:The clinical and following-up data of 319 patients with papillary thyroid microcarcinoma received surgery treatment from September 2011 to December 2014 were analyzed retrospectively.Total thyroidectomy and ipsilateral central lymph node dissection were performed in Group A(98cases),total thyroidectomy and bilateral central lymph node dissection were performed in Group B(187cases),while only total thyroidectomy or near-total thyroidectomy was performed in Group C(34cases).The incidence rate of operative complication and recurrence/metastasis were compared between the three groups.Results:The complication rates of permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism in Group A or Group C were both0%,while 1.1%、1.6%in Group B respectively.The rates of temporary recurrent laryngeal nerve palsy in Group A(7.1%)and Group B(8.0%)were higher than Group C(2.9%).The temporary hypoparathyroidism rates of three groups were 18.4%、34.2% and 5.9%.The follow up period was20-59 months,there was no mortality in this series.Lateral neck lymph nodes metastases were found in 1patient in Group A and 3patients in Group B.1patient was lung metastases in Group B.No patients relapsed or distant metastasies in Group C.Conclusions:The extent of surgical dissection of the cervical central region did effect the postoperative complication rates,especially the temporary hypoparathyroidism rate.Prophylactic ipsilateral or bilateral central lymph node dissection should be performed in accordance with clinicopathologic characteristics of papillary