预防性右侧喉返神经深层淋巴清扫术在右侧甲状腺乳头状非微小癌术中的必要性探讨

Prophylactic dissection of lymph node posterior to right recurrent laryngeal nerve of non-minimal papillary thyroid carcinoma in the right lobe

目的探讨预防性右侧喉返神经深层淋巴(LN-pr RLN)清扫术在右侧甲状腺乳头状非微小癌术中的意义。方法回顾性分析中山大学孙逸仙纪念医院甲状腺外科2013年1月至2014年12月395例右侧甲状腺乳头状非微小癌行中央区淋巴结(CCLN)清扫术的患者资料,根据术中是否行清扫术分为清扫组和未清扫组,其中清扫组205例,非清扫组190例。统计两组患者CCLN及LN-pr RLN的转移情况。结果清扫组发生CCLN转移53.17%,非清扫组51.58%,差异无统计学意义(x^2=3.34,P=0.345)。清扫组LN-pr RLN转移率为14.15%,低于中央区其他部位淋巴转移率(53.17%),差异有统计学意义(x^2=0.57,P=0.001)。清扫组患者的平均中央区阳性淋巴结为(6.7±1.4)个,而非清扫组为(5.2±1.4)个,差异有统计学意义(t=0.38,P=0.036)。两组患者均未出现永久性声嘶或永久性甲状旁腺功能低下。清扫组和非清扫组各有5例患者出现暂时性声嘶,差异无统计学意义(2.44%vs 2.63%,x^2=0.01,P=0.939);暂时性甲状旁腺功能低下发生率分别为17.07%(35/205)和9.47%(18/190),差异有统计学意义(x^2=0.42,P=0.027)。结论 LN-pr RLN是右侧甲状腺乳头状非微小癌的淋巴转移好发位置之一,预防性行LN-pr RLN清扫术增加了CCLN的阳性检出率,并可使分期更为准确。

Objective To investigate the role of prophylactic dissection of lymph node posterior to right recurrent laryngeal nerve（LN-pr RLN） of non-minimal papillary carcinoma in the right lobe of thyroid gland. Methods A retrospective analysis of three hundred and ninety-five patients was conducted of non-minimal papillary thyroid carcinoma in the right lobe from January 2013 to December 2014 of Sun Yat-sen Memorial Hospital. The patients were divided into prophylactic dissection group（205 cases） and non-prophylactic dissection group（190 cases）. Central compartment lymph node（CCLN） metastasis and LN-pr RLN was analyzed in the two groups. Results CCLN metastasis was found in 53.17% of prophylactic dissection group, and in 51.58% of non-prophylactic dissection group, with no significant difference（x^2=3.34, P=0.345）. In prophylactic dissection group, 14.15% of LN-pr RLN was found invasive, which was lower than other parts of central compartment lymph node district（53.17%, x^2=0.57, P=0.001）. Averagely,（6.7±1.4） CCLNs were found in prophylactic dissection group, whereas（5.2±1.4） in non-prophylactic dissection group, which was significantly different（t=0.38, P=0.036）. Neither permanent hoarse nor hypoparathyroidism was found in the two groups, but each group had 5 cases of transient hoarse with no statistically significant differences. Transient hypoparathyroidism was 17.07%（35/205） and 9.47%（18/190） in prophylactic dissection group and non-prophylactic dissection group, which had significant difference（x^2=0.42, P=0.027）. Conclusion LN-pr RLN metastasis of non-minimal papillary carcinoma is not uncommon, while prophylactic dissection of LN-pr RLN can increase detected positive metastatic rate of CCLN.