甲状腺乳头状癌颈部的处理

目的 探讨甲状腺乳头状癌颈部处理的最佳方案。方法 总结１９６５年１月～１９８７年１月４２４例甲状腺乳头状癌的临床资料，根治原发灶的同时，对颈部淋巴结阳性（Ｎ＋）患者进行颈清扫术，对颈部淋巴结阴性（Ｎ０）患者进行观察，待出现颈淋巴结转移后再行治疗性颈清扫术。所有患者均随访１０年以上。结果 ２５８例颈部Ｎ＋患者的５，１０年生存率分别为８４．３％和８０．４％，而１６６例Ｎ０患者的５，１０年生存率分别为９

Management of the neck for patients with thyroid papillary carcinoma

Objective To search an optimal management of the neck for patients with thyroid papillary carcinoma.Methods Clinical data of 424 cases with thyroid papillary carcinoma treated in our hospital from Jan, 1965 to Jan, 1987 were analyzed retrospectively. Patients with positive cervical lymph nodes (N ) were treated with radical excision of the primary tumor and neck dissection. For patients without cervical lymph node involvement (N 0 ),neck dissection was spared. On follow up, whenever cervical lymphatic node metastasis occurred, neck dissection was performed. All patients were followed up for more than 10 years.Results The 5 and 10 year survival rate of the 258 N patients was 84.3% and 80.4% respectively, and that of the 166 N 0 patients was 94.1% and 91.3% respectively. Twenty three N 0 cases later developed cervical lymph node metastasis. Their 5 and 10 year survival rate was 91.4% and 82.2% respectively after neck dissection.Conclusion Since only 13.9% of N 0 thyroid papillary carcinoma patients who did not receive neck dissection develop cervical lymph node metastases later, and their survival rate was just as good where neck dissection is postponed until metastases occur, prophylactic neck dissection seems unnecessary.