甲状腺乳头状癌单区域择区颈淋巴结清扫术应用价值

Value of Selective Single Level Neck Lymph Node Dissection in Papillary Thyroid Cancer

目的:探讨单区域择区颈淋巴结清扫术对甲状腺乳头状癌术前影像学提示侧颈部单发淋巴结转移中的疗效。方法:选取2007年1月-2014年1月收治的135例甲状腺乳头状癌患者,随机分成两组,其中单区域清扫组62例行单区域择区颈淋巴结清扫术,改良清扫组73例行改良性颈部淋巴结清扫术(Ⅱ、Ⅲ、Ⅳ、Ⅴ)。比较单区域择区颈淋巴结清扫术和改良性颈部淋巴结清扫术的疗效。结果:改良清扫组清扫转移淋巴结个数(1.85±0.70)个,多于单区域清扫组的(1.40±0.65)个,差异有统计学意义(P<0.05)。改良清扫组淋巴结多发转移率41.10%,高于单区域清扫组的19.35%,差异有统计学意义(P<0.05)。改良清扫组淋巴结微转移率21.92%,高于单区域清扫组的4.84%,差异有统计学意义(P<0.05)。单区域清扫组与改良清扫组5年累积复发率分别为4.0%、4.9%,差异无统计学意义(P>0.05)。结论:单区域择区颈淋巴结清扫可适用于甲状腺乳头状癌术前影像学提示侧颈部单发小淋巴结转移的患者,但仍需要更长时间的随访。

Objective:To investigate the efficacy of single level selective neck lymph node dissection in preoperative solitary lateral neck lymph node metastasis in papillary thyroid cancer.Method:From January 2007 to January 2014,135 patients with papillary thyroid cancer were selected.They were randomly divided into two groups,62 patients in the single dissection group underwent selective single level neck lymph node dissection,73 patients in the comprehensive dissection group underwent comprehensive lateral neck lymph node dissection(Ⅱ,Ⅲ,Ⅳ,Ⅴ).Recurrence rate were analyzed between selective single level neck lymph node dissection and comprehensive lateral neck lymph node dissection.Result:The mean number of metastatic lymph nodes of 1.85±0.70 in the comprehensive dissection group was higher than 1.40±0.65 in the single dissection group,the difference was statistically significant(P<0.05).The multiple metastasis rate 41.10%in the comprehensive dissection group was higher than 19.35%in the single dissection group,the difference was statistically significant(P<0.05).The lymph node micrometastasis rate of 21.92%in the comprehensive dissection group was higher than 4.84%in the single dissection group,the difference was statistically significant(P<0.05).The 5-year lateral neck recurrence rare was 4.0%in single dissection group,4.9%in comprehensive dissection group,there was no significant difference(P>0.05).Conclusion:Selective single level neck lymph node dissection may be done in selective patient of papillary thyroid cancer,who is preoperative solitary lateral neck lymph node metastasis.