分化型甲状腺癌Ⅵ区与Ⅱ-Ⅴ区淋巴转移的关系及预后

目的探讨分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ）区颈淋巴转移的特点，为临床选择正确术式提供依据。方法回顾性分析1984年3月至2000年12月，99例甲状腺癌患者在辽宁省肿瘤医院头颈外科进行初次手术，同期行颈清扫术，进行病理检查，术后随访，并对结果进行统计分析。结果99例分化型甲状腺癌中，乳头状甲状腺癌61例（双侧乳头状甲状腺癌1例），乳头滤泡混合型13例，滤泡状甲状腺癌25例。根据2002年UICCTNM分期：Ⅰ期60例，Ⅱ期1例，Ⅲ期5例，Ⅳ期33例。一侧腺叶及峡部切除80例，一侧腺叶及对侧大部或次全切除15例，全甲状腺切除术4例。全部患者同期颈清扫术104侧（双颈清扫5例），其中经典性清扫66例（68侧），改良性清扫33例（36侧）。术后病理检查淋巴结阳性83例（86侧），其中3例双侧淋巴结阳性，颈淋巴转移率为83．8％（83／99）。VI区阳性率37．5％（39／104），颈侧区（Ⅱ-Ⅴ区）阳性率76．9％（80／104），VI区和颈侧区淋巴结阳性率比较，差异有统计学意义（配对X^2检验，X^2=33．01，P〈0．01）。统计分析表明颈侧区淋巴转移和Ⅵ区淋巴转移无相关性（独立X。检验，X^2=2．08，Pearson列联系数C=0．14，P〉0．05）。10年、15年生存率分别为88．3％和84．5％。结论分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ区）淋巴转移率不同。不能仅从Ⅵ区转移判断颈侧区是否有转移。发生Ⅵ区淋巴转移的患者不比颈侧区（Ⅱ-Ⅴ区）淋巴转移的预后差，经过正确的外科治疗，预后较好。

Level Ⅵ and Ⅱ-Ⅴ cervical lymph node metastasis in differentiated thyroid carcinoma

OBJECTIVE: To explore the characters of the cervical lymph node metastasis in differentiated thyroid carcinoma, and to provide evidence for proper surgery of differentiated thyroid carcinoma. METHODS: From 1984 to 2000, 99 cases with differentiated thyroid carcinoma were performed thyroidectomy and neck dissection. The patients were followed up. A retrospective analysis was performed. Results In 99 cases with differentiated thyroid carcinoma, there were 61 papillary carcinoma, 13 papillary and follicular mixed carcinoma, 25 follicular carcinoma. According to 2002 UICC TNM classification, 60 cases were staged I, 1 case staged II, 5 cases staged III, 33 cases staged IV. Lobectomy and isthmectomy was performed in 80 cases, lobectomy was resected and opposite subtotal lobectomy in 15 cases, total thyroidectomy in 4 cases. One hundred and four neck dissection were performed in 99 cases (5 cases were bilateral neck dissection ). Among them, 66 (68 sides) were radical neck dissection, 33 (36 sides) were modified neck dissection. Pathological results showed that lymph nodes were positive in 86 sides of 83 cases. The rate of cervical lymph node metastasis was 83.8% (83/99). The positive rates of lymph node were 37.5% (39/104) in level VI and 76.9% (80/104) in II-V, which was statistically different (chi2 = 33.01, P < 0.01). The cervical lymph node metastasis in lateral area (level II-V) and that in VI had not relationship (chi2 = 2.08, P > 0.05). Ten and 15 year survival rates of all 99 cases were 88.3% and 84.5% respectively. CONCLUSIONS: The occurrence of lymph node metastasis in level VI and level II was different and no relationship .One can not judge whether lateral neck metastasis by the lymph node statue in level VI only . Although they all had good prognosis, patients with positive nodes in level VI were not worse than that in lateral neck (II-V).