微小型甲状腺乳头状癌颈淋巴转移的临床研究

Clinical Study of Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

目的探讨微小型甲状腺乳头状癌颈淋巴转移的临床意义。方法回顾性分析1998年5月～2001年12月住院治疗的27例微小型甲状腺乳头状癌患者,其中23例行颈清扫术,并与同期住院治疗的144例非微小型甲状腺乳头状癌进行对比。结果微小型与非微小型甲状腺乳头状癌颈部淋巴结转移分别为12/23(52.2%)、108/144(75.0%),淋巴结阳性率分别为29.7%、37.8%;Ⅵ区淋巴结转移分别为9/23(39.1%)、43/58(74.1%),淋巴结阳性率分别为32.0%、58.4%;Ⅰ—Ⅴ区淋巴结转移分别为11/23(47.8%)、93/144(64.6%),淋巴结阳性率分别为15.2%、34.9%,三者统计学均有显著性意义。10例临床颈部N_0微小型甲状腺乳头状癌患者,6例病理检查发现淋巴结转移。结论微小型甲状腺乳头状癌患者颈淋巴结转移比非微小型低,以颈静脉链为常见部位,其次是气管食管沟。对一个确诊为微小型甲状腺乳头状癌患者,都应行颈清扫术。

Purpose To study the clinical characteristics of cervical lymph node metastasis in the papillary microcarcinoma of the thyroid gland. Methods 27 cases of papillary microcarcinoma and 144 cases of papillary carcinoma of the thyroid gland were treated from May. 1998 to Dec. 2001. Their clinical characteristics of cervical lymph node metastasis were retrospectively analysed. Results The cervical lymph node metastasis in papillary microcarcinoma and papillary carcinoma were 12/23(52.2%) and 108/144(75.0%) respectively, and their positive rates of lymph node of neck dissection were 29. 7% and 37.8% respectively; In VI sites lymph node metastasis were 9/23 (39. 1%) and 43/58 (74.1%) and positive rates were 32.0% and58.4%; Lymph node metastasis in I-V sites were 11/23(47.8%) and 93/ 144 (64.6%), and positive rates were 15.2% and 58.4%. These factors were statistically significant. Conclusion Cervical lymph node metastasis in papillary microcarcinoma was lower than that in papillary carcinoma of thyroid gland, and that the jugular nodal chain involvement was seen more often than the tracheoesphageal nodes in papillary microcarcinoma. If a patient was diagnosed as papillary thyroid microcarcinoma definitely, he or she should be operated on with neck dissection.