摘要
目的探讨甲状腺乳头状癌cNO患者颈侧区淋巴结转移状况及规律。方法回顾性分析106例甲状腺乳头状癌cNO患者的临床及病理资料。所有患者均为首次手术，手术方式均为甲状腺全切除或近全切除＋中央区淋巴清扫＋颈侧区淋巴清扫。分析指标包括患者性别、年龄、原发灶大小、肿瘤是否多发、肿瘤T分级及中央区淋巴结转移状况，同时对肿瘤原发灶位置与颈侧区淋巴结转移区域的关系进行探讨。结果cNO甲状腺乳头状癌颈侧区淋巴结转移与男性（P=0．007）、原发灶最大径〉1cm（P=0．014）、肿瘤T分级为T3、T4（P=0．006）及中央区淋巴结阳性数≥2枚（P〈0．001）有关，而与年龄（P=0．947）及肿瘤是否多发（P=0．710）无关。颈侧区淋巴转移以Ⅲ区（47／116，40．5％）、Ⅳ区（41／116，35．3％）最常见，其次是Ⅱ区（18／116，15．5％），而Ⅴ区转移少见（2／29，6．9％）。其中89．8％（79／88）的Ⅲ、Ⅳ区淋巴转移发生于原发灶位于（或包含）甲状腺中下极的患者，77．8％（14／18）的Ⅱ区淋巴转移发生于原发灶位于（或包含）甲状腺上极的患者，83．3％（15／18）的Ⅱ区转移同时伴随着Ⅲ区转移。2例Ⅴ区淋巴转移的患者都伴有Ⅱ、Ⅲ、Ⅳ区同时转移。结论对于男性、肿瘤为B、T4级及中央区淋巴结阳性数≥2枚的甲状腺乳头状癌患者建议术中常规清扫颈侧Ⅲ、Ⅳ区淋巴结，如肿瘤位于甲状腺上极或Ⅲ区淋巴结阳性者还应清扫Ⅱ区，只有当Ⅱ、Ⅲ、Ⅳ区同时有淋巴转移时才应考虑Ⅴ区淋巴清扫术。对于肿瘤最大径≤1em且局限于甲状腺内及无中央区淋巴转移的甲状腺乳头状癌患者不建议行预防性颈侧区淋巴清扫术。
Objective To study the pattern of lymph node spread in papillary thyroid carcinoma （PTC） with clinically negative node（cNO）. Methods A total of 106 patients with cNO PTC who underwent total or subtoyal thyroidectomy plus unilateral or bilateral lateral neck dissection （LND, level Ⅱ - Ⅴ or level Ⅰ - Ⅴ ） at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively. Results The lateral neck lymph node metastasis in cNO PTC was significantly associated with sex （ male, P = 0. 007 ） , tumor stage （ T3/T4, P = 0. 006） , tumor size （ 〉 1 cm, P = 0. 014） and the number of positive central lymph nodes（≥2, P 〈0. 001 ） , but not with age and muhifocal tumor. Level Ⅲ （47/116, 40.5% ） was the most prevalent metastatic site, followed by level Ⅳ （41/116, 35.3%）, level Ⅱ （18/116, 15.5%） and level Ⅴ （2/29, 6.9%）. Of the cases with lymph node metastases in level Ⅲ and Ⅳ, 89.8% （79/88） of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes, while in the cases with lymph node metastases in level Ⅱ , 77.8% （ 14/18 ） of primary thyroid tumors in the upper sites of the thyroid lobes, and 83.3% of cases with level Ⅱ metastases were accompanied with level Ⅲ metastases. Two cases with level V metastases were accompanied with metastases in levels Ⅱ , Ⅲ and IV. Conclusions LND should be considered for cNO PTC in male, with T3/T4 lesions and positive central lymph nodes≥2, and the range of dissection should include level Ⅲ and Ⅳ. Dissection of level Ⅱ should be considered in cNO PTC with primary tumor localized in the upper site of the thyroid lobe or with level Ⅲ metastasis. Dissection of level Ⅴ should be considered at present of metastases in level Ⅱ , Ⅲ, and Ⅳ. For cNO PTC with tumor size 〈 1 cm, confined to the thyroid and without lymph node metastasis in the central compartment, LND is not recommended.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2012年第8期662-667,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
甲状腺肿瘤
癌
乳头状
颈淋巴结清扫术
Thyroid neoplasms
Carcinoma, papillary
Radical neck dissection
