甲状腺乳头状癌的淋巴结转移规律及其清扫范围探讨

Pattern of lymph node metastasis and the extent of lymph node dissection in papillary thyroid carcinoma

摘要:

目的：甲状腺乳头状癌（papillary thyroid carcinoma，PTC）常发生淋巴结转移（lymph node metastases，LNM）。而对于淋巴结清扫（lymph node dissection，LND）范围仍存在争议，本文主要研究 PTC 的 LNM 规律及其影响因素，为 LND 范围提供依据。方法：回顾性分析 2010年２月-2013年２月我院收治的 96 例 PTC 患者资料，所有患者均行中央区和颈侧区 LND，标本分区标记送病检，对肿瘤大小，部位及包膜浸润等详细检查。结果：LNM 以Ⅵ区（65.6%）最高，其次为Ⅲ区 59.4%、Ⅱ区 43.8%、Ⅳ区 36.5%，Ⅴ区8.2%。性别（P=0.019）和包膜浸润（P=0.026）是 LNM 的重要影响因素，中央区 LNM 是颈侧区LNM的重要影响因素（P=0.014）。结论：患侧中央区 LNM率高，应行患侧中央区 LND；中央区LNM情况有助于决定是否行颈侧区LND及其清扫范围。

Abstract:

Objective：Papillary thyroid carcinoma is often complicated with lymph node metastases（LNM） and extent of lymph node dissection（LND） is under disscussion. The objectives of this retrospective study were to evaluate the pattern and predictive factors of cervical LNM and to determine the optimal lymph node management strategy. Methods：Between February 2010 and February 2013，96 patients who underwent surgical treatment for PTC at our hospital were retrospectively analyzed. All patients underwent LND at central and lateral sides. Neck dissection specimens were marked and separated according to neck levels and sent for pathology examination. Results：Overall，63 patients（65.6%） had nodal metastases to level Ⅵ，57（59.4%） to level Ⅲ，42（43.8%） to level Ⅱ，35（36.5%） to level Ⅳ，8（8.2%） to level Ⅴ. Gender（P=0.019） and extracapsular invasion（P=0.026） were significant predictive fac－tors of cervical LNM，and central LNM was significantly related with lateral LNM（P=0.014）. Conclusions：Ipsilateral central LND is recommended for all PTC patients. Whether to perform lateral LND and the extent of lateral LND are determined by results of central LND.