甲状腺乳头状癌颈侧区淋巴结转移的再手术:是否清扫中央区淋巴结

Reoperation for papillary thyroid carcinoma with metastasis to lateral lymph node: central lymph node dissection

目的 :对首次甲状腺乳头状癌手术未清扫中央区淋巴结,术后颈侧区淋巴结复发转移,再行颈侧区淋巴结清扫术时,是否需清扫中央区淋巴结进行探讨。方法:回顾性分析2003年1月至2014年12月在八五医院和瑞金医院外科手术治疗的44例甲状腺乳头状癌病人资料。结果:首次手术44例中12例甲状腺癌肿位于甲状腺上极病人,再次手术发现颈侧区淋巴结有转移而中央区淋巴结无转移;余32例癌肿位于甲状腺中下极或下极,再次手术发现颈侧区和中央区淋巴结均有转移。术后有5例(11.36%,5/44)出现暂时性声音嘶哑,7例(15.91%,7/44)出现暂时性低钙血症。结论:对首次手术未行中央区淋巴结清扫而甲状腺癌肿位于中下极或下极的病人,再次手术行颈侧区淋巴结清扫时,需清扫中央区淋巴结;但探查中央区无异常肿大淋巴结,可不清扫。对癌肿位于甲状腺上极的病人,为降低手术风险也可不清扫中央区淋巴结。

Objective To discuss whether the central lymph node should be dissected with the metastasis to lateral lymph node in the reoperation in the patients with papillary thyroid carcinoma who were not done the dissection of central lymph node in the first operation. Methods The clinical data of 44 cases with papillary thyroid carcinoma from January2003 to December 2014 at the Department of General Surgery of The 85 th Hospital and the Department of Surgery of Ruijin Hospital were analyzed retrospectively. Results Twelve cases with the carcinoma of superior pole of thyroid were found the metastasis of later lymph node but without the metastasis of central lymph node. Both central and lateral lymph node had metastasis in 32 cases with the carcinoma of middle-lower or lower lobe of thyroid. There were transient vocal hoarseness in 5 cases（11.36%, 5/44） and transient hypocalcemia in 7 cases（15.91%, 7/44）. Conclusions It is suggested in this study that both central and lateral lymph node should be dissected in the reoperation for the patients with carcinoma of middle-lower or lower lobe of thyroid. Dissection of central lymph node might be not done if the abnormal lymph node was not found. The recommendation that only lateral lymph node is dissected for the carcinoma of superior pole of thyroid could be given for decreasing of operative risk.