cN0甲状腺乳头状癌颈淋巴结选择性清除术的意义及方式探讨

Discussion on the significance and methods of selective dissection of cervical lymph nodes of cN0 papillary thyroid carcinoma

目的探讨甲状腺乳头状癌颈淋巴结转移规律,为选择最佳手术方式提供参考。方法回顾性分析2012年1月~2016年1月宁德市闽东医院618例诊断为c N0甲状腺乳头状癌患者的临床和病理资料,术前、术中腺体内注射美蓝,切除甲状腺同时常规清扫中央区,根据淋巴结染色情况选择性清扫颈侧区。结果 618例有完整统计资料的c N0甲状腺乳头状癌患者中,病理诊断颈部蓝染淋巴结总转移率为88.19%(3347/3795),中央区(Ⅵ区)淋巴结转移率为89.49%(3006/3359),颈侧区(Ⅱ、Ⅲ、Ⅳ)蓝染淋巴结转移率为78.21%(341/436),其中Ⅱ区72.81%(83/114)、Ⅲ区80.46%(140/174)、Ⅳ区79.73%(118/148)。结论甲状腺乳头状癌最常见的转移部位是Ⅵ区,术中应常规清除,其次依次为Ⅲ、Ⅳ、Ⅱ、Ⅴ区,对于c N0患者也应选择性行颈部淋巴结清扫术,美蓝进行术前标记转移淋巴结方法可行,对于临床术式选择有一定的指导意义,值得推广应用。

Objective To investigate the principle of cervical lymph node metastasis in papillary thyroid carcinoma and to provide a reference for the selection of the best surgical method. Methods The clinical and pathological data of 618 cases diagnosed as CN0 thyroid papillary carcinoma from January 2012 to January 2016 in Ningde Mindong Hospital were retrospectively analyzed. Gland injection of methylene blue was performed before surgery and after surgery. The central region was routinely dissected while the thyroid gland was dissected. According to lymph node staining, the lateral neck region was selectively dissected. Results Among 618 patients with CN0 thyroid papillary carcinoma who had complete statistics, the total metastasis rate of cervical blue-stained lymph node was 88.19%（3347/3795） according to pathological diagnosis. The metastasis rate of central region（region Ⅳ） lymph node was 89.49%（3006/3359）. The metastasis rate of blue-stained lymph nodes in the lateral cervical regions（ Ⅱ 、Ⅲ 、Ⅳ） was 78.21%（341/436）. Among them,region Ⅱ was 72.81%（83/114）, region Ⅲ was 80.46%（140/174）, and region Ⅳ was 79.73%（118/148）. Conclusion The most commonly seen metastatic site of papillary thyroid carcinoma is region Ⅳ, which should be routinely removed in the surgery, followed by region Ⅲ, Ⅳ, Ⅱ and Ⅴ. For c N0 patients, cervical lymphadenectomy should also be selected.Methylene blue for preoperative marking lymph node metastasis is feasible, which has a certain guiding significance for the selection of clinical surgical methods, and is worthy of promotion and application.