临床无淋巴结转移甲状腺微小乳头状癌预防性中央区淋巴结清扫193例临床分析

Preventive Central Lymph Node Dissection for Papillary Thyroid Microcarcinoma without Lymph Node Metastasis:Analysis of 193 Cases

目的分析临床无淋巴结转移(clinical lymph node negative,cN0)甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)中央区淋巴结转移(central lymph node metastasis,CLNM)的相关危险因素,探讨预防性中央区淋巴结清扫(central lymph node dissection,CLND)在其治疗中的意义。方法回顾性分析193例行预防性CLND的cN0期PTMC患者的临床病理资料。观察术后并发症及预后随访情况,分析CLNM相关危险因素。结果193例患者中有65例(33.7%)存在CLNM,淋巴结转移与性别、年龄无明显相关(P<0.05),肿瘤直径≥5 mm、肿瘤侵犯腺体被膜、多发原发灶(单侧,≥2个)、双侧腺叶发病、喉前淋巴结阳性的患者CLNM转移风险显著增加(P<0.05)。193例患者中1例发生甲状旁腺永久性损伤,2例发生喉返神经永久损伤。结论cN0期PTMC存在较高的CLNM率,且与多个因素相关,建议在有手术技术保障的条件下行预防性CLND。

Objective To analyze the related risk factors of central lymph node metastasis(CLNM)of clinical papillary thyroid microcarcinoma(PTMC)with clinical lymph node negative(cN0),and explore the significance of preventive central lymph node dissection(CLND)in the treatment of PTMC.Methods The clinicopathological data of 193 cases of cN0 stage PTMC patients with preventive CLND were retrospectively analyzed.Postoperative complications and prognostic follow-up were observed,and the correlation between clinicopathological data and CLNM were analyzed.Results In 193 patients,65 cases(33.7%)had CLNM.Lymph node metastasis was not significantly related to gender and age(P<0.05).However,patients with tumor diameter≥5 mm,thyroid capsule invasion,multiple primary tumors(unilateral,≥2),bilateral gland lesions and positive prelaryngeal lymph nodes,have a significantly increased risk of CLNM(P<0.05).Among 193 patients,1 case had permanent parathyroid injury and 2 cases had permanent recurrent laryngeal nerve injury.Conclusion There is a high CLNM rate in cN0 PTMC,which is related to many factors.It is recommended to perform preventive CLND under the condition of surgical technology guarantee.