摘要
目的探讨甲状腺乳头状癌淋巴结转移的规律,为临床行选择性颈淋巴结清扫术提供依据。方法回顾性分析华中科技大学附属协和医院乳腺、甲状腺外科中心2003年6月至2006年6月间行甲状腺癌根治＋颈淋巴结清扫术,且颈清扫的淋巴结数目大于8枚的83例甲状腺乳头状癌临床资料。结果甲状腺乳头状癌最容易转移至Ⅵ区（单侧甲癌72.3%,双侧甲癌88.9%）,其次是Ⅲ、Ⅳ区（单侧甲癌57.9%,双侧甲癌50%～66.7%）,Ⅴ区和Ⅰ区较少发生淋巴结转移（单侧甲癌0%～20.1%,双侧甲癌25%～33.3%）。侵犯甲状腺包膜（88%）和滤泡亚型（85.7%）的甲状腺癌容易发生颈淋巴结转移。良性病变局部恶变（27.3%）和包膜型（25%）甲状腺癌,较少发生颈淋巴结转移。甲状腺上极的肿瘤可以先出现颈外侧区淋巴结转移。结论甲状腺乳头状癌的淋巴结转移的研究有助于确定选择性颈淋巴结清扫术范围,建议甲状腺乳头状癌常规清扫Ⅵ区淋巴结,肿瘤位于甲状腺下极者需清扫对侧下极淋巴结;对于肿瘤位于甲状腺上极的患者,应增加清扫Ⅱ、Ⅲ区的淋巴结。对风险较高的滤泡亚型及侵犯包膜的甲状腺乳头状癌清扫范围要更大,应清扫Ⅱ～Ⅵ区淋巴结。
Objective To study the patterns of cervical lymph node metastases in cases of papillary thyroid cancer （PTC）. Methods The clinical data of 83 PTC patients who underwent radical thyroidectomy and modified radical neck dissection with more than 8 lymph nodes dissected in each individual case from June 2003 to June 2006 were collected and retrospectively analyzed. Result IN PTC cases lymph node metastasis was commonly seen in the level of Ⅵ central group（ in 72. 3% unilateral PTC cases and 88. 9% bilateral PTC cases） and level Ⅲ, Ⅳ lateral group（ in 57.9% unilateral PTC eases and 50% -66.7% bilateral PTC eases）. Metastasis was rare in level Ⅴ and Ⅰ （in 0% -20. 1% unilateral PTC cases and 25% ～33.3% bilateral PTC cases）. Follicular PTC （85.7%） or PTC with thyroid capsular invasion （88%） tended to have a metastasis to the cervical lymph node. Only a small portion of benign thyroid diseases with focal canceration （27.3%） and well encapsulated PTC （25%） had lymph node metastasis. In some upper pole PTC the metastatic lymph nodes in the lateral group may precede the lymph node metastasis in the central compartment. Conclusion The regular pattern of cervical lymph node metastases of PTC could be used to guide selective lymph node dissection. Routine Ⅵ central group lymph node dissection is advocated in cases of follicular PTC. In cases of lower PTC the contralateral level Ⅵ lymph node dissection should be included, The upper pole PTC should be treated by selective neck dissection （ at least levels Ⅱ , Ⅲ ）. High risk PTC （ capsular invasion and variant follicular PTC） should undergo selective LND at levels Ⅱ through Ⅵ.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第7期524-526,共3页
Chinese Journal of General Surgery
关键词
甲状腺肿瘤
淋巴转移
淋巴结切除术
Thyroid neoplasms
Lymphatic metastases
Lymph node excision
作者简介
通信作者：黄韬，E—mail：huangtaowh@163．net。
