甲状腺癌咽旁/咽后淋巴结转移的临床诊治与预后分析

目的探讨甲状腺癌咽旁/咽后淋巴结转移的临床特点、治疗方法与预后。方法回顾性分析2007年1月至2016年12月因咽旁/咽后淋巴结转移行手术治疗的28例甲状腺癌患者的临床资料，总结其临床病理与手术治疗特点及预后情况。其中男10例，女18例；年龄20～78岁，中位年龄55岁。5例为初治患者，23例为再次治疗患者（其中15例有侧颈部淋巴结清扫史）。采用Kaplan-Meier法分析患者生存状况，采用log-rank检验对患者5年生存率进行单因素分析。结果16例转移淋巴结位于鼻咽部或口咽部水平（舌骨平面以上），12例转移淋巴结位于喉咽部水平（舌骨平面以下）。所有患者均经颈部切口入路达根治性切除。全组患者术后出现局部或颈部淋巴结复发5例，出现咽旁淋巴结复发2例，伴远处转移8例。随访中死亡5例，其中1例死于肺转移，3例死于颈部肿瘤进展，1例死于恶病质，5年累积生存率82.5%。单因素分析显示，咽旁/咽后淋巴结转移的部位对生存率的影响有统计学意义（P＜0.05）。结论甲状腺癌咽旁/咽后淋巴结转移虽然病期较晚，但通过积极治疗，预后仍较好。颈部切口入路手术切除是其主要治疗手段。喉咽部水平（舌骨平面以下）转移者预后相对较差。

Parapharyngeal/retropharyngeal lymph node metastasis from thyroid carcinoma and its relation to treatment and prognosis of patients

Objective To analyze parapharyngeal/retropharyngeal lymph node metastasis from thyroid carcinoma and its relation to treatment and prognosis of patients. Methods Clinical data of 28 thyroid carcinoma patients with parapharyngeal or retropharyngeal lymph nodes metastasis admitted between January 2007 and December 2016 were analyzed retrospectively. There were 10 males and 18 females with a median age of 55 years (20-78 years). There were 5 newly diagnosed cases and 23 cases receiving thyroidectomy previously (including 15 cases with neck dissection). SPSS 19.0 software was used for data procession, Kaplan-Meier method used to survival analysis, Log-rank test used for single factor analysis. Results Sixteen cases had metastatic lymph nodes above the nasopharyngeal or oropharyngeal level (above the hyoid plane), 12 cases had metastatic lymph nodes under the laryngeal pharynx level (below the hyoid plane).All patients had lesion resected via the transcervical approach. Five cases developed local or neck lymph nodes recurrence, 2 cases developed pharyngeal lymph node recurrence, 8 cases developed distant metastasis. Five cases died, including 1 from pulmonary metastasis, 3 from cervical tumor progress and from cachexia. The overall 5-year survival rate was 82.5%. Conclusion The prognosis of thyroid carcinoma patients with parapharyngeal or retropharyngeal lymph node metastasis can be still good after active treatment. Metastasis lymph nodes below the hyoid plane level may indicate poor prognosis.