cN0期分化型甲状腺癌行中央区淋巴结清扫及预防性侧颈淋巴结清扫的价值

目的:探讨cN0期(颈淋巴结阴性)甲状腺癌患者同时行中央区淋巴结清扫及预防性侧颈淋巴结清扫的价值.方法:总结56例分化型甲状腺癌患者的病例资料,特别是手术方法、中央区淋巴结是否转移与侧颈淋巴结转移的关系、原发灶大小与中央区淋巴结转移关系及随访等情况,比较无行预防性侧颈淋巴结清扫(A组)与有行预防性侧颈淋巴结清扫(B组)患者的疗效.结果:56例患者中17例中央区淋巴结转移阳性(A组7例,B组10例),其中11例有侧颈淋巴结转移(A组3例,B组8例),转移率为65%(11/17);39例中央区淋巴结转移阴性,其中6例有侧颈淋巴结转移(A组4例,B组2例),转移率为16%(6/39).中央区淋巴结转移阳性与阴性的转移率比较差异具统计学意义,P<0.01.56例中47例原发病灶最大径小于或等于4 cm,中央区淋巴结转移阳性11例(23%);9例原发病灶最大径超过4 cm,6例(6/9)中央区淋巴结转移阳性,两者转移率比较差异具统计学意义,P<0.05.A组7例(23%)复发,B组3例(12%)复发,两组复发率比较差异具统计学意义,P<0.05.结论:对cN0期甲状腺癌患者行中央区淋巴结清扫十分必要.术中应常规将中央区淋巴组织送检,有转移阳性者应行预防性侧颈淋巴结清扫.

The significance of central cervical lymph node dissection and prophylactic lateral cervical dissection in treatment of the cN0 differentiated thyroid carcinoma

Objective: To evaluate the significance of central cervical lymph node dissection and prophylactic lateral cervical lymph node dissection in treatment of cN0 differentiated thyroid carcinoma.Methods: Clinical data of 56 patients with differentiated thyroid carcinoma was reviewed and summarized.The cases were divided into Group A(n=30) or B(n=26),in which prophylactic lateral cervical lymph node dissection was applied or not,respectively.Results: Among the 56 patients,there were 17 case of central cervical lymph node metastasis(7 and 10 cases in Group A and B,respectively),in which there were 11 cases of lateral cervical lymph node metastasis(3 and 8 cases in Group A and B,respectively),with metastasis rate of 65%(11/17).Among the 39 cases without central neck lymph node metastasis,there were 6 cases of lateral cervical lymph node metastasis(4 and 2 cases in Group A and B,respectively),with the metastasis rate of 16%(6/39).There was significant difference in metastasis rate between the two groups (P<0.01).The primary lesion maximum size no more than 4 cm was observed in 47 cases,among which there were 11 cases(23%) with central cervical lymph node metastasis.Among the other 9 cases,there were 6 cases(6/9) with central cervical lymph node metastasis,with significant difference with that in those with smaller primary lesion size(P<0.05).Relapses were revealed in 7(23%) and 3(12%) cases in Group A and B,respectively,with significant difference between them(P<0.05). Conclusion: Dissection of central cervical lymph node is necessary for treatment of cN0 differentiated thyroid carcinoma.Intraoperative frozen section pathological diagnosis of central cervical lymph tissues should be performed for guidance of prophylactic dissection of lateral cervical lymph node.