双侧中央区清扫在CNO单侧甲状腺微小乳头状癌中的意义

Value of bilateral central neck dissection in patients with clinically node-negative papillary thyroid microcarcinoma

目的研究甲状腺微小癌中央区淋巴结转移的危险因素，探索CN0甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）中央区淋巴结清扫的合理范围。方法前瞻性收集福建医科大学附属协和医院甲状腺外科2015年12月至2016年12月CN0期PTMC患者共200例，按照住院号尾数的单双，分成单侧中央区清扫组和双侧中央区清扫组，分析其淋巴结转移的相关因素，并进一步分析双侧中央区清扫的清扫效果和并发症。结果PTMC中央区淋巴结转移的相关危险因素为肿瘤直径≥0．7cm、患者年龄≥45岁和男性。进一步分析发现，对侧中央区淋巴结转移均发生在肿瘤直径≥0．5cm的患者，对侧中央区淋巴结转移阳性率为22％。该部分患者单侧和双侧中央区清扫淋巴结检出数分别为（9．53±6．04）枚和（12．19±7．18）枚，P=0．035；淋巴结阳性数分别为（1．17±1．47）枚和（2．11±2．75）枚，P=-0．022。结论在肿瘤直径≥0．5cm的患者中，双侧中央区清扫有利于提高肿瘤清扫的彻底性：患者RLN麻痹和甲状旁腺功能减退的风险并不因对侧中央区清扫而增加。

Objective To study the risk factors of lymph node metastasis in the central neck compart- ment of thyroid carcinoma, and to explore the reasonable range of lymph node dissection in central neck dissec- tion for clinically node-negative papillary thyroid mieroearcinoma patients. Methods From Dec. 2015 to Dee. 2016, a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups ac- cording to the registration number： unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery, Fujian Medical University Union Hospital. The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed. Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were /〉 0.7 em in diameter and older than 45 years in age and gender in male. Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm. The positive rate was 22%. The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18, P=0.035, respectively. The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75, P=0,022 respectively. Conclusion In patients with tumor diam- eter ≥0.5 em, bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.