甲状腺乳头状癌术中喉前及气管前淋巴结联合冷冻病理检测的临床价值

目的:探讨甲状腺乳头状癌(PTC)术中喉前淋巴结(DLN)及气管前淋巴结(PLN)联合冷冻病理检测的临床价值。方法:收集2015年1月—2016年12月昆明医科大学第二附属医院甲状腺乳腺外科术前经细针穿刺活检明确诊断并接受首次手术治疗的245例PTC患者的临床资料,患者均行DLN与PLN术中冷冻病理检测,并根据DLN与PLN转移情况选择手术方式。结果:245例患者术中冷冻病理均发现DLN与PLN,淋巴结数目2～11枚,126例(51.43%)发现DLN与PLN转移。术后病检气管旁淋巴结转移165例,侧颈区淋巴结转移62例。76例行单侧腺叶及峡部全切+患侧中央区淋巴结清扫,42例行全甲状腺切除+患侧中央区淋巴结清扫,101例行全甲状腺切除+双侧中央区淋巴结清扫,26例行全甲状腺切除+双侧中央区淋巴结清扫+侧颈区清扫。统计分析表明包膜侵犯是DLN与PLN转移的独立风险因素(OR=9.62,P=0.021)。结论:DLN与PLN可作为PTC前哨淋巴结,其转移与气管旁淋巴结转移、侧颈区淋巴结转移密切相关。术中行DLN与PLN联合冷冻病理检测有助于选择最佳手术方式,实现对PTC更加精准的治疗。

Clinical value of intraoperative frozen section analysis for prelaryngeal and pretracheal lymph nodes in surgery for papillary thyroid carcinoma

Objective: To investigate the clinical value of intraoperative frozen section analysis for prelaryngeal/Delphian lymph nodes (DLN) and pretracheal lymph nodes (PLN) in surgery for papillary thyroid carcinoma (PTC). Methods: The clinical data of 245 patients with PTC diagnosed by preoperative fine-needle aspiration biopsy and accepted the first-time surgery in the Department of Thyroid and Breast Surgery of the Second Affiliated Hospital, Kunming Medical University from January 2015 to December 2016 were collected. All patients underwent intraoperative frozen section examination for both DLN and PLN, and then surgical procedures were decided according to the metastasis status of the DLN and PLN. Results: DLN and PLN were detected in the intraoperative frozen sections for all the 245 patients, with the number of lymph nodes ranged from 2 to 11, and DLN and PLN metastases were found in 126 patients (51.43%). Paratracheal lymph node metastases were found in 165 patients, and lateral cervical metastases were found in 26 patients by postoperative pathological examination. Seventy-six patients underwent unilateral lobectomy with isthmusectomy plus ipsilateral central neck dissection, 42 patients underwent total thyroidectomy plus central neck dissection of the affected side, 101 patients underwent total thyroidectomy plus bilateral central neck dissection, and 26 patients underwent total thyroidectomy plus bilateral central neck dissection along with lateral neck dissection. Results of statistical analyses demonstrated that capsular invasion was an independent risk factor for DLN and PLN metastases (OR=9.62, P=0.021). Conclusion: DLN and PLN can be considered as the sentinel lymph nodes of PTC, and their metastases are closely related to paratracheal lymph node and lateral cervical lymph node metastases. The intraoperative frozen section examination for DLN and PLN will help to choose the best surgical procedure and thereby provide more precise treatment for PTC.