cN0分化型甲状腺癌颈部中央区淋巴结术中快速病理对颈侧区淋巴结清扫的指导意义

目的探讨中央区淋巴结术中快速病理检测对侧颈区淋巴结清扫的指导意义。方法回顾性分析2016年1月至2018年1月宿迁地区8家二级以上综合医院收治的1 292例临床检查淋巴结阴性分化型甲状腺癌(cN0 DTC)患者的临床资料。术中先行中央区淋巴结清扫,行快速病理检测,然后再进行侧颈区淋巴结清扫。根据中央区和侧颈区淋巴结转移情况分为4组再进行综合分析。结果1 292例中,共有468例患者发生颈部淋巴结转移,转移率为3622％;男性、>45岁、肿瘤直径大、原发灶数目多、有包膜浸润及周围组织侵犯是淋巴结转移的独立危险因素。术中快速病理中央区淋巴结转移阳性数>2枚患者,其侧颈区淋巴结转移比例高于中央区淋巴结转移阳性数≤2枚的患者(781％ vs. 214％),差异有统计学意义(P<005)。结论中央区淋巴结可以作为前哨淋巴结在术中进行快速病检,可根据中央区淋巴结转移数决定cN0分化型甲状腺癌侧颈区淋巴结的清扫范围。

The guiding significance of rapid pathology in the central lymph node for the lateral cervical lymph node dissection in cN0 differentiated thyroid carcinoma

Objective　To investigate the significance of rapid pathology in the central lymph node for the lateral cervical lymph node dissection in cN0 differentiated thyroid carcinoma. Methods　1292 patients of cN0 DTC were treated with central lymph node dissection and rapid pathological examination during operation, and then the lateral neck lymph node dissection was performed and analyzed from January 2016 to January 2018 among eight second level and above hospitals. Then the patients were divided into four groups for comprehensive analysis according to the lymph node metastasis in central and lateral neck regions. Results　Among 1292 patients, 468 patients had cervical lymph node metastasis, with a metastasis rate of 36.22%. There were independent risk factors for lymph node metastasis, including male, above 45 years old, large tumor diameter, large number of primary lesions, capsule infiltration and surrounding tissue invasion. The rate of the lateral cervical lymph node metastasis in the central lymph node metastasis greater than 2 was higher than that in the central lymph node metastasis less than or equal to 2(78.1% vs. 21.4%, P<0.05). Conclusions　The lymph nodes in the central region can be used as sentinel nodes for rapid intraoperative disease detection. According to the number of lymph node metastases in the central region, the lymph node dissection range in the lateral cervical region of cN0 differentiated thyroid cancer was determined.