甲状腺乳头状癌行预防性中央区淋巴结清扫的争议、共识与对策

Controversy, consensus and treatment strategies on prophylactic central neck dissection in clinical lymph node negative papillary thyroid carcinoma

对术前或术中检查中央区淋巴结阴性(cN0)的甲状腺乳头状癌(PTC)是否行预防性中央区淋巴结清扫(pCND)目前还存在争议性。尽管pCND对cN0 PTC病人长期存活率、复发率和术后甲状腺球蛋白的影响仍不明确,但能够清除中央区潜在的转移淋巴结,有利于手术的彻底性和降低再手术时并发症的发生率,有利于术后准确分期和合理选择放射性碘治疗,并对颈侧方淋巴结转移具有一定的预测价值。2012年我国《甲状腺结节及分化型甲状腺癌诊治指南》及国内学者主流观念,推荐对cN0 PTC病人行病灶同侧的pCND。在行pCND时,应该确保手术范围的规范,减少术后并发症的发生。

The significance of prophylactic central neck dissection （pCND） in clinical lymph nodes negative （cN0） papillary thyroid carcinoma （PTC） patients remains controversial. Although the effects of pCND on long-term survival, recurrence, and postoperative Tg are still unclear. However, pCND can remove the potential metastatic central lymph nodes, be beneficial to the thoroughness of the operation, reduce the complications of reoperation, be helpful to postoperative staging and radioiodine treatment and also can predict the lateral lymph nodes metastasis. Therefore,ipsilateral pCND is recommended by 2012 Guideline for the Treatment of Thyroid Nodules and Differentiated Thyroid Cancer in China and mostly domestic scholars.Surgeons should also ensure standard dissection extent and decrease postoperation complications during pCND.