中央区的界定及细化在甲状腺癌治疗中的意义

Significance of the definition and detailing of the central neck compartment in the treatment of thyroid carcinoma

甲状腺癌作为最常见的头颈部恶性肿瘤，颈淋巴结转移是其复发率增高和生存率降低的危险因素，尤其是年龄〉145岁者。20％-90％的分化型甲状腺癌患者在确诊时即存在颈淋巴结转移，多发生于颈部中央区。规范中央区淋巴结及各亚分区的解剖范围，对于甲状腺癌的手术范围、预后评估、个体化治疗方案的选择显得尤为重要。本文就中央区淋巴结区域的解剖界定、组成部分及细化的各亚分区在甲状腺癌中的作用进行逐一阐述，认为中央区淋巴结的解剖上界至舌骨、下界至头臂干动脉平面，侧界至颈总动脉，上纵隔淋巴结应成为中央区淋巴结的一个重要亚分区组成部分，在行颈中央区淋巴清扫术中，应重视上纵隔淋巴结的转移。

The cervical lymph node metastasis is a risk factor for the high recurrence rate and low survival rate in patients with thyroid carcinoma （ especially for age ≥ 45 years old ） , which is the most common head and neck carcinoma. The neck lymphatic metastasis, mostly occurring in the central neck compare, is diagnosed among 20%-90% of patients with differentiated thyroid carcinoma. To definite the anatomic boundaries of the central lymph nodes and their subgroups is significantly important for thyroid carcinoma, such as the determination of surgical extent, the evaluation of prognosis and the choice of different treatment strategies. This paper aims to describe the anatomic boundaries and the components of the central neck compartment and the role of individual subgroups in thyroid carcinoma. We think that the central neck compartment is bounded superiorly by the hyoid bone, inferiorly by the innominate artery on the right and the corresponding axial plane on the left, laterally by the carotid arteries. The superior mediastinal lymph nodes should be the important subgroups of the central neck compartment in thyroid carcinoma. When the prophylactic central lymph node dissection for involved lymph nodes is performed in thyroid carcinoma, we should pay more attention to the superior mediastinal lymph nodes.