甲状腺乳头状癌行预防性中央区淋巴结清扫的纷争

Controversy of prophylactic central dissection for cN0 papillary thyroid carcinoma

中央区淋巴结转移可发生于高达80%的甲状腺乳头状癌(PTC)患者中,但对患者的生存率无明显影响。对临床检查阴性的中央区淋巴结(c N0)行预防性清扫(p CLD),可清除潜在病灶,有助于术后的准确分期和复发危险度分层,指导后续治疗,并降低再次手术的并发症发生率,但可能增加甲状旁腺功能减退等并发症的风险。所以,对是否需常规性p CLD,各家指南或多或少有所保留,但对肿瘤较大、分期较晚、多灶癌、有包膜侵犯、或不良病理学亚型的PTC,建议积极的p CLD,同时术中应注意喉返神经的全程暴露和甲状旁腺及其血供的保护。大宗的临床研究数据将为争议的解决提供依据。

Even if cervical lymph node micro-metastases are observed in up to 80% patients with papillary thyroid cancers （PTC）, of whom postoperative survival are still good. Whether prophylactic central lymph node dissection （pCLD） should be performed in all patients with cN0 PTC remained controversial. However, pCLD could not only remove potential metastatic lesions, but also be helpful of postoperative staging . It could reduce the complications of re-operation, but might increase the risk of hypoparathyroidism of the first operation. Nevertheless, selective surgical options in high-risk cases is supported by recent clinical guidelines. Standardized dissection should be performed and complications should be avoided during pCLD. Prospective randomized trials are still needed to evaluate the benefits of different approaches for better clinical outcome.