甲状腺癌上纵隔转移淋巴结分区的初步探讨

A study on the metastasis related location of superior mediastinal lymph nodes in thyroid cancer

目的探讨甲状腺癌上纵隔转移淋巴结分区方法,以提供精确的解剖学定义:方法收集2018年9月至2019年11月在浙江大学医学院附属邵逸夫医院诊断为甲状腺癌伴上纵隔淋巴结转移36例患者,分析手术方式、并发症及随访结果。结果将上纵隔淋巴结分为10个区域:1、2Ra、2Rb,、2La、2LI,、3A、3P、4R、4La和4Lb区。根据上纵隔转移灶位置,选用经颈部直视、腔镜辅助、胸腔镜、腔镜辅助联合胸腔镜或传统正中开胸手术平均随访时间为(10±4)个月,所有病例均未见上纵隔肿瘤残留或复发结论甲状腺癌上纵隔淋巴结分区可以提供精确的解剖学定义,并能为外科医师选择合适的手术方式提供参考。

Objective To explore superior mediastinal lymph node zoning of thyroid cancer for accurate anatomical definition as a reference for surgical access.Methods A method for zoning superior mediastinal lymph nodes for thyroid cancer was proposed.From Sep 2018 to Nov 2019,36 cases of thyroid cancer with superior mediastinal lymph nodes metastases were reviewed.The diagnosis,surgical approaches,pathology,characteristics of lymph node metastasis,complications and follow-up results were analyzed.Results The superior mediastinal lymph nodes were grouped into 10 areas:1,2Ra,2Rb,2La,2Lb,3A,3P,4R,4La and 4Lb.According to the location of the superior mediastinum metastatic lymph nodes,direct vision approach through the neck incision,laparoscope-assisted approach,thracoscepy,laparoscope-assisted combined with thrascopy approach or conventional median sternotomy was performed for regional lymph node dissection.The average follow-up time was(10±4)months.No residual or recurrence of tumor in superior mediastinal area was found.Conclusions The zoning of the superior mediastinal lymph nodes in thyroid cancer can be used as a guide for surgical approach to lymph node dissection.