甲状腺乳头状癌患者中央区及侧颈部淋巴引流通路的临床研究

目的通过淋巴示踪剂对甲状腺乳头状癌（PTC）患者中央区及侧颈部淋巴引流可能通路进行探讨。 方法以52例同期行中央区及侧颈部淋巴结清扫术的淋巴结病理阳性（pN+）或临床淋巴结阳性（cN+）PTC患者为研究对象。所有患者术中注射淋巴示踪剂（纳米炭混悬注射液），并对显影的淋巴引流通路进行观察。 结果通过术中观察，未见淋巴引流通路显影11例，淋巴引流通路显影41例，显影率78.8%（41/52）。其中，中央区及侧颈部淋巴引流通路同时显影24例，仅中央区淋巴引流通路显影12例，仅侧颈部淋巴引流通路显影5例。中央区淋巴引流通路存在：沿甲状腺下极血管走行的下行淋巴引流通路，沿甲状腺中极向外侧往颈鞘深面走行的侧方淋巴引流通路，沿甲状腺上极血管走行的上行淋巴引流通路，并且各通路间存在广泛的吻合网。侧颈部淋巴引流通路存在：沿甲状腺下极血管下行经颈鞘深面到达侧颈部Ⅳ区的淋巴引流通路，沿甲状腺中极向外侧单独经颈鞘深面到达侧颈部Ⅲ、Ⅳ区的淋巴引流通路，沿甲状腺上极血管上行到达颈动脉三角，然后经颈鞘表面到达侧颈部，再沿颈鞘外侧下行行走的淋巴引流通路。 结论通过淋巴示踪剂追踪可发现甲状腺乳头状癌存在多条淋巴引流通路，侧颈部淋巴结可不通过中央区淋巴结而直接转移。

Clinical study of lymphatic drainage pathways in central and lateral neck of patients with papillary thyroid carcinoma

ObjectiveTo explore possible lymphatic drainage pathways in the central and lateral neck of patients with papillary thyroid carcinoma (PTC) using a lymphatic tracer. MethodsTotally 52 patients with pathologically node positive (pN+) or clinically node positive (cN+) PTC who underwent central and lateral neck dissection were enrolled in the study. All patients were injected intraoperatively with the lymphatic tracer (nanocarbon suspension injection) and observed developed lymphatic drainage pathways. ResultsThrough intraoperative observation, 41 patients developed lymphatic drainage pathways, while 11 patients did not. The development rate was 78.8% (41/52). Twenty-four patients simultaneously developed lymphatic drainage pathways in the central and lateral neck, of which 12 merely developed central lymphatic drainage pathways and 5 merely developed lateral cervical lymphatic drainage pathways. Central lymphatic drainage pathways included a descending lymphatic drainage pathway along lower vessels of thyroid gland, a lateral lymphatic drainage pathway along middle vessels of thyroid gland outwards to the deep neck sheath, and an ascending lymphatic drainage pathway along upper vessels of thyroid gland, and there are multiple anastomotic networks between those pathways. Lateral cervical lymphatic drainage pathways included a lymphatic drainage pathway along lower vessels of thyroid gland to the Ⅳ area of lateral neck through the deep neck sheath, a lymphatic drainage pathway along middle vessels of thyroid gland outwards to the Ⅲ and Ⅳ areas of lateral neck through the deep neck sheath, and a lymphatic drainage pathway which traveled up to the carotid triangle along upper vessels of thyroid gland, reached to the lateral neck through the superficial neck sheath, and then descended along the outer neck sheath. ConclusionSeveral lymphatic drainage pathways can be found in PTC using the lymphatic tracer, and the lymphatic metastasis can be directly transferred to the lateral neck without passing through the central area.