术前超声联合增强CT对甲状腺乳头状癌中央区淋巴结转移的诊断价值

目的　比较分析术前超声、增强CT、超声联合增强CT三种方法对甲状腺乳头状癌（papillary thyroid carcinoma，PTC）中央区淋巴结转移的诊断效能。方法  回顾性分析中山大学肿瘤防治中心头颈外科同一治疗小组完成的339例PTC病例。所有病例均在术前完成甲状腺及颈部淋巴结的超声及增强CT检查，对中央区淋巴结是否转移做出影像学诊断，并与病理进行对照。结果　假设以超声和/或CT发现中央区淋巴结做为转移性淋巴结的诊断标准，超声、增强CT、超声+增强CT的敏感度分别为75.62%、91.04%、97.01%，特异度分别为55.07%、55.80%、34.78%，准确度分别为67.26%、76.70%、71.68%。当以US和/或CT的典型的PTC转移性淋巴结特征做为诊断标准时，US、CT、US+CT的敏感度分别为58.21%、74.13%、84.58%，特异度分别为86.23%、77.54%、71.01%，准确度分别为69.62%、75.52%、79.06%。结论　超声和CT联合应用可提高PTC中央区转移性淋巴结诊断效能。     

中央区浅层淋巴结与甲状腺乳头状癌右喉返神经后方淋巴结的相关研究

目的　自右颈中央区浅层（右颈VI-1区）淋巴结转移情况探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）患者何时需行右喉返神经后方淋巴结（1ymph node behind the right recurrent laryngeal nerve,LN-prRLN）清扫术。方法　自2014年3月～2015年9月杭州市第一人民医院集团306例右侧或双侧PTC患者,分析右颈VI-1区淋巴结转移情况、转移个数、转移灶大小对LNprRLN转移的预测价值。结果　右颈VI-1区淋巴结转移个数以及转移灶大小对于预测LN-prRLN转移有统计学差异,当右颈VI-1区淋巴结转移个数为1.5个,其敏感度及特异度分别为78.43%及76.65%,其曲线下面积（area under curve,AUC）值为0.813;当右颈VI-1区淋巴结转移灶大小为0.45 cm时,其敏感度为90.20%,特异度为48.90%,其AUC值为0.726,具有诊断价值。结论　双侧或右侧PTC患者,当右颈VI-1区淋巴结转移个数≥2个且转移灶＞0.45 cm时,需行LN-prRLN清扫。     

超声诊断对甲状腺乳头状腺癌中央区清扫的临床指导意义

目的:探讨超声诊断对甲状腺乳头状腺癌(特别是甲状腺微小灶癌)是否行中央区淋巴结清扫的临床指导意义。方法:分析2012-09-2013-12期间在我科(同一术者、同一标准)进行甲状腺乳头状腺癌行中央区淋巴结清扫手术的临床资料121例,评价术前超声对甲状腺微小灶癌和非微小灶癌中央区淋巴结转移的诊断价值。结果:121例患者中甲状腺微小灶癌(原发病灶d≤1.0cm)62例,其颈中央区淋巴结超声诊断的准确率为74.2%(46/62),漏诊率为61.9%(13/21),误诊率为7.3%(3/41),灵敏度为38.1%(8/21)、特异度为92.7%(38/41),阳性预测值为72.7%(8/11),阴性预测值为74.5%(38/51),Kappa值为0.3485(<0.4),表示在PTMC中术前超声与术后病理诊断一致性较差;非微小灶癌(原发病灶d>1.0cm)患者59例,其术前超声中央区淋巴结诊断的准确率为55.9%(33/59),漏诊率为58.3%(21/36),误诊率为21.7%(5/23),灵敏度为41.7%(15/36),特异度为78.3%(18/23),阳性预测值75.0%(15/20),阴性预测值为46.2%(18/39),Kappa值为0.1757(<0.4),表示超声诊断与术后病理诊断一致性仍较差。结论:甲状腺微小灶癌术前中央区淋巴结超声诊断提示可疑阳性的,需常规行颈中央区淋巴结清扫。对于中央区淋巴结超声提示阴性的,可结合患者高危因素决定是否行预防性颈中央区淋巴结清扫。非微小灶型甲状腺乳头状腺癌中央区淋巴结超声检查无论是否提示有无异常淋巴结,均应行颈中央区淋巴结清扫。     

侧颈部淋巴结示踪技术在甲状腺癌手术治疗中的应用

目的 探究纳米炭示踪技术在甲状腺癌侧颈部淋巴结评估中的价值。 方法 研究为前瞻性、多中心队列研究,纳入体格检查阴性、影像学怀疑侧颈部淋巴结转移的甲状腺乳头状癌患者。术中用纳米炭示踪后进行侧颈部淋巴结清扫术。根据是否炭染,将侧颈部淋巴结分区送检,统计两组淋巴结的分区以及转移情况,并根据患者的临床病理特征进行亚组分析。以颈部淋巴结清扫的结果作为金标准,计算前哨淋巴结活检的敏感度及准确率。 结果 122例患者接受示踪手术,共计颈部淋巴结125例/侧。其中有侧颈部淋巴结转移117例,有中央区淋巴结转移7例,无颈部淋巴结转移1例。炭染淋巴结的中位数为6枚,其分布为Ⅳ区>Ⅲ区>Ⅱ区>Ⅴ区,分布规律与肿瘤大小、位置、腺外侵犯无关。炭染淋巴结的转移概率在各个淋巴结分区中均显著高于非炭染淋巴结(Ⅱ区:19.9%比5.6%,P<0.001;Ⅲ区:35.0%比18.3%,P<0.001;Ⅳ区:37.1%比15.2%,P<0.001;Ⅴ区:14.8%比3.7%,P<0.05)。侧颈部前哨淋巴结活检的敏感度为89.5%,准确率为91.8%。 结论 侧颈部淋巴结的炭染规律与甲状腺癌淋巴引流的规律基本一致,炭染淋巴结的转移概率显著高于非炭染淋巴结,是潜在侧颈部前哨淋巴结活检的示踪方法。     

彩超结合CT分区评估甲状腺乳头状癌淋巴结转移的探讨＊

目的：探讨术前彩超结合增强CT分区评估甲状腺乳头状癌淋巴结转移的价值。方法：收集术前行颈部彩超同时行颈部、纵隔薄层增强CT检查的115例（141侧）甲状腺乳头状癌的临床资料,分为彩超组、CT组及彩超结合CT组分析比较三组在评估不同区域甲状腺乳头状癌淋巴结转移中的作用。结果：评估颈中央区淋巴结转移,彩超、CT及彩超结合CT三组的准确率分别是61．0％,48．9％,62．4％;评估颈侧区淋巴结转移,彩超、CT及彩超结合CT三组的准确率分别是87．9％,78．7％,85．8％。彩超在颈中央区（P〈0．05）及颈侧区（P〈0．05）评估淋巴结转移的准确率均高于CT。彩超结合CT检查在颈中央区的准确率高于CT（P〈0．05）,而在颈侧区的准确率与CT比较差异无统计学意义（P〉O．05）。无论在颈中央区（P〉0．05）或在颈侧区（P〉0．05）,彩超与两者联合检查的准确率比较无统计学差异。术前CT考虑6例纵隔转移及1例咽旁间隙转移,术后病理证实均为淋巴结转移。纵隔增强CT扫描发现5例患者肺部转移。结论：彩超结合CT或单一彩超评估颈中央区及颈侧区甲状腺乳头状癌淋巴结转移的准确性要高于CT。CT可以评估纵隔等彩超探及不到的区域淋巴结转移,同时对肺部转移进行评估。彩超结合增强CT应用于甲状腺乳头状癌淋巴结的评估,较单一检查更加精确、全面。     

儿童分化型甲状腺癌的临床特征及治疗体会

目的 探讨儿童分化型甲状腺癌的临床特征和治疗特点。 方法 回顾分析经手术治疗的18岁以下的分化型甲状腺癌32例的临床资料。 结果 32例患者中男8例,女24例。发病年龄<14岁11例,≥ 14岁21例;累及双侧甲状腺19例,单侧13例。多发病灶23例,单发病灶9例;肿瘤≥1 cm 30例,<1 cm 2例;病理证实甲状腺乳头状癌27例,甲状腺滤泡状癌5例;发生颈淋巴结转移25例,转移率为78.13%,颈部Ⅰ~Ⅵ区及上纵隔区均有淋巴结转移,各区转移率分别为 3.13%、31.25%、31.25%、37.50%、9.38%、68.75%、25.00%;发生甲状腺外侵12例,肺转移5例,甲状腺癌术后颈部淋巴结转移10例。随访1~14年,无死亡病例。 结论 儿童分化型甲状腺癌具有侵袭性强、转移率高、复发率高、死亡率低的临床特点,甲状腺全切除术和规范的颈结清扫术值得高度重视。     

纳米碳在甲状腺乳头状癌隐匿性侧颈转移淋巴结清扫术中的临床应用价值

目的 探讨纳米碳在甲状腺乳头状癌隐匿性侧颈转移淋巴结清扫术中的临床应用价值。 方法 60例临床淋巴结阴性甲状腺乳头状癌在术中注射纳米碳,切除黑染侧颈淋巴结送冰冻病理,根据病理情况决定淋巴结清扫范围。 结果 60例患者术中侧颈淋巴结黑染58例,冰冻病理证实淋巴结阳性12例,行侧颈淋巴结清扫术12例。术后随访未见局部复发。 结论 临床N0甲状腺乳头状癌通过术中注射纳米碳示踪可增加侧颈隐匿性转移淋巴结检出率,减少阳性淋巴结漏诊率,提高手术效果。     

彩超在诊断分化型甲状腺癌颈淋巴结转移中的应用

目的评价彩超在诊断甲状腺癌患者颈淋巴结转移中的作用.方法回顾性分析1998年2月～2002年2月收治51例颈淋巴转移的甲状腺癌患者的临床资料：30例（34侧）颈部可触及有肿大淋巴结并经彩超检查诊断有颈淋巴结转移;21例（24侧）颈部未触及有肿大淋巴结但彩超检查诊断有颈淋巴结转移.对上述58侧颈部实行改良性颈清扫,将术前彩超检查结果与术后病理结果进行比较.结果彩超诊断有颈淋巴结转移的58侧行改良性颈清扫术后53侧病理报告有转移淋巴结,彩超检查的灵敏度为91.4%（53/58）.4例患者在随访过程中发现颈侧区淋巴结转移,复发率为7.5%.彩超可以发现39.6%有临床漏诊颈淋巴结转移的患者.术前彩超检查：中颈淋巴转移率最高71.7%（38/53）;术后病理检查：Ⅲ区淋巴转移率最高67.9%（36/53）,其结果基本相同.结论彩超在术前可以判断是否发生颈淋巴结转移并能够准确定位,在甲状腺癌的术前颈淋巴结的评价中十分重要,甲状腺癌患者应常规进行术前彩超检查.     

喉癌患者术前中性粒细胞/淋巴细胞比值与淋巴结转移的相关性研究

目的 研究探讨喉癌患者术前中性粒细胞/淋巴细胞比值(NLR)与淋巴结转移的关系。 方法 选取2008年1月至2017年12月广西医科大学附属肿瘤医院收治的102例喉癌患者,以术前NLR为因变量对喉癌临床病理分期及淋巴结检测结果进行分析。 结果 术前NLR>2.2患者的转移度和转移率高于NLR≤2.2的患者(P<0.001);术前NLR>2.2组的患者中,淋巴结分期(N+)>N0者多于术前NLR≤2.2组(P<0.001)。肿瘤早期(T1,T2)患者的NLR均值较局晚期(T3,T4)的低,后者的淋巴结转移率和转移度较高(P<0.001);临床Ⅳ期患者NLR的均值、淋巴结转移率和转移度明显较Ⅲ期的高(P<0.05)。声门上型、声门型的患者中,术前NLR>2.2组的淋巴结转移率及转移度高于NLR≤2.2组(P<0.05);声门下型的患者中,淋巴结转移率差异比较无统计学意义(P>0.05),而淋巴结转移度差异比较有统计学意义(P<0.05)。 结论 喉癌患者术前NLR的高低与淋巴结转移之间有相关性,能在一定程度上反映淋巴结转移的程度,可为临床治疗提供有价值的参考依据。     

中央区淋巴结清扫在甲状腺乳头状癌手术中的价值

目的:探讨中央区淋巴结清扫在甲状腺乳头状癌处理中的作用。方法:收集我院2011-2012收治的136例甲状腺乳头状癌患者,所有患者在切除原发灶的同时均进行同侧中央区淋巴结清扫,临床颈侧区淋巴结转移的患者行颈侧区功能性淋巴结清扫术。结果:136例患者中央区淋巴结阳性率为56.6%(77/136),其中临床淋巴结阴性(cN0)患者,中央区淋巴结阳性率为47.5%(48/101),临床淋巴结阳性(cN1)患者,中央区淋巴结阳性率为82.9%(29/35),差异具有统计学意义。结论:在没有增加手术风险的情况下,切除甲状腺癌原发灶的同时应该行同侧中央区淋巴结清扫。     

甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的：探讨甲状腺乳头状癌颈部淋巴结转移规律及其相关影响因素,为甲状腺乳头状癌颈部淋巴结清扫术提供一定的临床依据。方法：回顾性分析314例甲状腺乳头状癌患者的临床资料。314例患者中,行甲状腺腺叶峡部切除、中央区淋巴结清扫术79例,甲状腺全切、中央区淋巴结清扫术173例,甲状腺全切、中央区淋巴结清扫术、侧颈部改良根治性颈部淋巴结清扫术62例。手术中清扫出淋巴结1～55个,其中阳性淋巴结0～14个。结果：314例患者中经病理证实共有168例（53．50％）患者有淋巴结转移,其中中央区淋巴结转移159例（50．64％）,中央区＋侧颈转移淋巴结55例（17．52％）,单纯侧颈淋巴结转移9例（2．87％）。患者年龄、肿瘤直径、甲状腺被膜受侵犯、临床分期是甲状腺乳头状癌颈部淋巴结转移的影响因素（P〈0．05）。结论：甲状腺乳头状癌患者最常发生中央区淋巴结转移,应常规进行中央区淋巴结清扫术。     

高频超声诊断下咽鳞癌淋巴结转移的临床研究

目的 探讨高频超声在诊断下咽鳞癌颈淋巴结转移的应用价值。方法 收集于耳鼻咽喉科接受颈淋巴结清扫术的47例下咽鳞状细胞癌患者的临床资料,以病理检查结果为金标准,对颈部触诊、颈部强化CT、高频超声检查结果,以kappa值反映三种方法结果与金标准的一致程度,以灵敏度、特异度评价三种检查方法的诊断效果;用Pearson χ²检验比较三种方法的灵敏度和特异度。结果 研究纳入下咽癌患者47例,所有患者均无远处转移病灶。三种检查方法,超声检查与病理检查的一致性最好(Kappa=0.718)。以术后病理检查结果为准,对于下咽癌颈淋巴结转移,超声诊断的灵敏度最高(91.9%)、高于触诊,差异有统计学意义;超声灵敏度也有高于强化CT(78.9%)的趋势,但差异无统计学意义。在特异度方面,触诊最高(94.74%)、超声(78.95%)次之、强化CT(61.11%)最低,三者的差异均无统计学意义。结论 对于诊断下咽癌颈淋巴结转移,高频超声检查具有较高的灵敏度及特异度,可为临床诊断及所采用的手术方式提供重要信息,因其无创、便携、可重复等优点,可作为监测下咽癌颈部淋巴结转移的重要辅助手段。     

Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma

The value of ultrasound in detecting central compartment lymph node metastasis in patients with well-differentiated thyroid carcinoma (WDTC) is unclear. Prospective patients with WDTC attending a university-affiliated tertiary medical center between July 2010 and June 2011 underwent neck ultrasound for detection of central compartment lymph node metastases prior to surgery. Central lymph node dissection was performed during the initial surgery regardless of ultrasound findings. The sensitivity and specificity of preoperative ultrasound in detecting central lymph node metastases were calculated according to the final histopathological results. Sixty-four patients met the study criteria. Twenty-four had pathologic central compartment lymph nodes according to preoperative ultrasound, 20 of which were confirmed by histological examination. One patient was found to have pathological central lymph nodes by histology which was not detected by US. Sensitivity of preoperative ultrasound was 95 %, specificity 90 %, and negative and positive predictive values 97 and 83 %, respectively. Preoperative ultrasound may serve as an accurate and important tool for deciding the extent of surgery in WDTC.     

Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer

There is little data that determine the clinical characteristics of prelaryngeal lymph nodes (PLN) metastasis in patients with papillary thyroid cancer (PTC). The aims of this prospective study were to evaluate the incidence and the clinical characteristics of metastasis to the PLN for PTC patients who underwent total thyroidectomy and prophylactic central neck dissection. Sixty-seven patients who underwent total thyroidectomy and prophylactic bilateral central lymph node neck dissection for PTC were enrolled. Central neck compartment was further divided into prelaryngeal, ipsilateral/contralateral paratracheal, and pretracheal regions. Clinicopathologic factors including age, sex, tumor size and location, extrathyroidal extension, and central and lateral nodal metastasis were evaluated. Of the 67 patients who underwent PLN dissection, 13 (19.4 %) had evidence of PLN metastasis. Tumor size was significantly larger in patients with PLN involvement (2.28 versus 1.12 cm; p = 0.020). Additionally, primary tumors larger than 1 cm, extrathyroidal extension, and isthmus involvement were more prevalent in PLN-positive patients. Patients with positive PLNs were also more frequently found to have lateral lymph node metastasis (23.1 vs. 1.9 %; p = 0.021), pretracheal lymph node metastasis (76.9 vs. 27.8 %; p = 0.003), and bilateral central lymph node metastasis (38.5 vs. 11.1 %; p = 0.031) than PTC patients without PLN involvement. The incidence of PLN metastasis in PTC patients who underwent prophylactic central lymph node neck dissection was 19.4 %. PLN metastasis was associated with tumor size, extrathyroidal extension, isthmus involvement, and other compartment lymph node metastasis.     

Sonographically-directed neck dissection for recurrent thyroid carcinoma

Objective: To determine the effectiveness of sonographically‐directed compartmental neck dissection for recurrent differentiated thyroid carcinoma as confirmed by ultrasound surveillance and thyroid‐specific biochemical markers. Study Design: Retrospective chart review. Methods: Retrospective cohort study of 18 patients with sonographically localized and pathology‐confirmed recurrent differentiated thyroid carcinoma. Fifteen patients chose to undergo compartmental neck dissection by a single surgeon. Surgery involved central compartment (level VI) or functional lateral neck dissection (level II‐IV+/‐V). Three patients declined surgery despite proven recurrent lymph node disease. Results: All 18 patients started out with sonographic evidence of recurrent lymph node disease. Preoperative thyroglobulin or thyroglobulin antibody levels were positive in 17 of 18 patients (94%). Postoperatively, all 15 patients who underwent compartmental lymph node dissections had no sonographic evidence of lymph node disease. Of the 14 patients with preoperative positive thyroglobulin or thyroglobulin antibody levels, 9 patients converted to negative levels (64%). Furthermore, two of four patients (50%) converted to thyroglobulin antibody negative status after surgery. All three patients who declined surgery had persistently detectable sonographic nodal disease in addition to positive thyroglobulin and/or thyroglobulin antibody levels (100%). Surgical complications were minimal and self‐limited as no patient experienced permanent cranial nerve deficits. Conclusion: Ultrasound‐directed cranial nerve sparing compartmental lymph node dissection results in no sonographically detectable cervical lymph node disease and undetectable basal thyroglobulin or thyroglobulin antibody levels in the majority of patients with low morbidity.     

Diagnosis of lateral cervical lymph node metastasis of papillary carcinoma of the thyroid by ultrasonography

No consensus for papillary carcinoma of the thyroid exists on the preoperative diagnosis of lateral cervical lymph node metastasis, indications, or range of neck dissection, so we studied the usefulness and limits of ultrasonography and sufficient dissection by comparing preoperative ultrasonographic and postoperative histopathological diagnosis. Subjects were 45 patients (51 affected sides) with lateral cervical lymph node metastasis of papillary carcinoma of the thyroid who underwent modified neck dissection between July 1997 and July 2003. Preoperative ultrasonographic and postoperative histopathological diagnosis were compared. Specimens excised by neck dissection contained 1,325 lymph nodes. Of these, 198 (15%) detected by preoperative ultrasonography were selected for investigation of diagnostic criteria for metastasis-positive lymph nodes. The best criterion for the diagnosis of metastasis-positive lymph node was 0.5 or greater [minor axis/major axis] with 6 mm or greater minor axis at levels III, IV, or V (7 mm or greater at level II), and sensitivity, specificity, and accuracy were 78%, 100%, and 84% respectively. The lateral cervical lymph node metastasis rate obtained by this diagnostic criterion was 41%. Regional histopathological metastasis positivity was investigated in the lateral cervical region, and high positivity rates were obtained: 57% at level II, 71% at level III, and 84% at level IV. Considering these findings and the preoperative ultrasonographic diagnosis rate of 41%, sufficient dissection at levels II-IV may be necessary for patients in whom lateral cervical metastasis is observed before surgery. The metastasis rate was 10% at level V, but dissection should always be done in lateral cervical metastasis-positive patients because: 1) No trend was observed in age, gender, the number of metastatic lymph nodes, or regional metastasis rate; 2) no anatomical boundary is present between levels II, III, IV and level V; 3) no functional disorder due to preservation of the accessory nerve occurred; 4) the prognosis of patients with advancement to the accessory nerve was poor; and 5) improvement of the prognosis of papillary carcinoma of the thyroid by modified radical neck dissection has been reported.     

Prophylactic neck dissection for submandibular gland cancer

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in T1, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma, 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomyohoid neck dissection is suitable for N0 cases of submandibular gland cancer because of four reasons: 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in N0 cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.     

下咽癌颈淋巴结转移的颈侧清扫探讨

目的 为了探讨颈侧清扫可否应用于临床Ｎ＋的下咽癌的颈部治疗。方法 对９３例下咽部颈清扫标本的转移性淋巴结在颈部的分布进行了回顾性分析。结果 颌下淋巴结转移占３．２％。Ｎ０,Ｎ１,Ｎ２ａ和Ｎ２ｂ～Ｎ３的颈后三角淋巴结转移率分别为：５．９％,７．０％,３７．５％和３６．０％。病理证实仅有颌下淋巴结转移或上、中颈深淋巴结转移,而无下颈深淋巴结转移时,颈后三角淋巴结转移率为４．０％,有下颈深淋巴结转移时,     

甲状腺乳头状癌临床NO患者颈部淋巴结转移规律

目的 探讨甲状腺乳头状癌临床NO( clinical NO,cN0)患者颈部淋巴结转移规律和外科处理方式.方法 前瞻性研究2007年8月至2010年9月51例甲状腺乳头状癌cNO患者.术前采用核素法和染料法定位前哨淋巴结,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.记录51例患者53侧颈部淋巴结清扫转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布情况.研究患者年龄、肿瘤多中心病灶、被膜外侵、肿瘤大小、中央区淋巴转移数目与颈侧区淋巴转移的关系,影响颈侧区淋巴转移率单因素差异比较采用x2检验,Logistic模型进行多因素分析.结果 颈部淋巴结隐匿性转移率77.4％ (41/53),颈侧隐匿性转移率58.5％(31/53),中央区淋巴转移≥3枚是颈侧区淋巴转移的独立危险因素.pNO 12侧,pN+41侧,17侧仅有1个分区转移,占pN+的41.5％( 17/41);2个或2个以上分区转移24侧,占pN+的58.5％( 24/41).转移淋巴结分布以Ⅵ区最常见,为62.3％(33/53),其次为Ⅲ区52.8％(28/53),Ⅳ区30.2％(16/53),Ⅱ区18.9％(10/53),Ⅴ区0％ (0/53).结论 甲状腺乳头状癌cNO患者隐匿性淋巴结转移以多区转移为主,Ⅵ、Ⅲ、Ⅳ、Ⅱ区常见.中央区淋巴转移≥3枚较易出现颈侧淋巴转移,对cNO患者选择性清扫Ⅱ、Ⅲ、Ⅳ、Ⅵ区能清除大部分存在的颈部隐匿性转移淋巴结.