甲状腺乳头状癌颈淋巴结转移规律与手术方式的选择

Surgical method of papillary thyroid carcinoma according to the metastatic patterns of lymph nodes in the neck

目的:从甲状腺乳头状癌颈部淋巴结转移规律探讨其最佳手术方式。方法:回顾性分析我院近三年367例甲状腺乳头状癌(papillary thyriod carcinoma,PTC)根治术患者的临床及病理资料。结果:颈淋巴结总转移率为77.11%(283/367),中央区(Ⅵ区)转移率为70.30%(258/367),颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)转移率为62.67%(230/367),颈侧区中的Ⅱ区转移率最高60.49%(222/367)。发病年龄、原发灶个数、肿瘤是否累及被膜、癌灶直径、肿瘤边界是否清晰、癌灶位置、超声血流信号分级、癌症是否合并桥本氏甲状腺炎或结节性甲状腺肿对颈部淋巴结转移的影响差异均有统计学意义(P<0.05);性别因素及癌灶是否钙化对颈部淋巴结转移的影响差异无统计学意义(P>0.10),经logistic回归分析发现,肿瘤是否累及被膜对颈部淋巴结转移的影响因素最大。结论:Ⅵ区是甲状腺乳头状癌最常见的转移部位,术中应常规清除,其次依次为Ⅱ、Ⅲ、Ⅳ、Ⅴ区。对于患者原发肿瘤若累及包膜、或多发病灶、或癌灶直径>1 cm及患者发病年龄<45岁等应同时做颈侧区清扫。

Objective：To explore the regularity of cervical lymph node metastasis of papillary thyroid carcinoma and to select an appropriate surgical method for papillary thyroid carcinoma.Methods：The clinical and pathological data of 367 cases of papillary thyroid carcinoma treated in our hospital for nearly three years were retrospectively analyzed.Results：The total lymph node metastasis rate was 77.11%（283/367）.The lymph node metastasis rate was 70.30%（258/367） in area VI and was 62.67%（230/367） in area Ⅱ,Ⅲ,Ⅳ and Ⅴ.There was significant relationship between the age of patients,number of the original tumor,amicula invasion,tumor diameter,tumor boundaries,tumor location,the classification of ultrasonic flow signal,the cancer whether merger with Hashimoto＆#39;s thyroiditis or goiter for the impact of cervical lymph node metastasis（P〈0.05）,while the gender factor and whether the cancer foci calcified was not.Conclusion：The area VI is the most common sites of metastases of papillary thyroid carcinoma,it should be routinely cleared in the surgery,followed by the order are the area Ⅱ,Ⅲ,Ⅳ,Ⅴ.When the tumor is amicula invasived,or with multiple lesions,or tumor diameter is〉1 cm or the patients age〈45 years,the side cervical lymph nodes should also be dissected.