摘要
目的探讨颈部中央区淋巴结清扫在临床上未发现淋巴结转移(cN0)甲状腺乳头状癌患者中应用的意义。方法收集1998年1月至2006年4月收治的641例 cN0甲状腺乳头状癌患者的临床病理资料,统计分析中央区淋巴结的转移情况,并分析其与患者的性别、年龄、原发灶大小及数目的关系。同时对治疗5年以上的114例患者进行随访,分析颈侧区淋巴结转移和对侧甲状腺腺叶复发与初治时中央区淋巴结病理情况的关系。结果 cN0甲状腺乳头状癌患者颈部中央区淋巴结转移的阳性率为53.0%。中央区淋巴结转移与原发灶的 T 分期和数目有关,与患者的性别和年龄无关。随访的114例患者中12例发生同侧颈侧区淋巴结转移,其中11例患者第一次手术时中央区淋巴结的转移阳性率较高。5例对侧甲状腺腺叶再发乳头状癌,其初治时中央区淋巴结病理情况差异较大。结论 cN0甲状腺乳头状癌患者应常规行中央区淋巴结清扫;中央区淋巴结病理情况与肿瘤原发灶的数目有关;中央区淋巴结转移阳性率高者易出现同侧颈侧区淋巴结转移。
Objective To assess the significance of central compartment dissection in papillary thyroid cancer with negative clinical lymph node metastasis. Methods Clinical and pathological data of 641 papillary thyroid cancer patients with negative clinical lymph node metastasis who were treated from January 1998 to April 2006 were collected. The positive rate of the lymph nodes metastasis was analyzed. The relations between the central compartment lymph nodes and the patients＇gender, age, tumor size and number were concerned. Among the 641 cases,ll4 case who received operation more than five years were followed up for the relations between the pathological status of central compartment lymph nodes and ipsilateral neck metastasis or contra thyroid lobe recurrence. Results The median number of the central compartment lymph nodes was 4 each case and 53.0% （340/641） cases of papillary thyroid cancer patients with negative clinical lymph node metastasis had positive central compartment lymph nodes metastasis, large tumor size and multiple origins were related to central compartment lymph nodes involvement, but the patients＇ gender or age was not. In the 114 follow-up cases, ipsilateral neck metastasis occurred in 12 cases, among which 11 cases had high positive central compartment lymph nodes metastasis. Contra thyroid lobe recurrence occurred in 5 cases, whose statuses of central compartment lymph nodes were different. Conclusions Papillary thyroid cancer patients with negative clinical lymph node metastasis deserve formal central compartment dissection. The pathological status of central compartment lymph nodes relates to the tumor size and number. High positive rate of central compartment lymph nodes may lead to possible ipsilateral neck metastasis.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第7期470-472,共3页
Chinese Journal of Surgery
