cNO期甲状腺乳头状腺癌颈淋巴结清扫适应证探讨

目的探讨cNO期甲状腺乳头状腺癌患者行颈淋巴结选择性清扫手术治疗的适应证.方法对162例甲状腺乳头状腺癌患者行颈淋巴结清扫术的资料进行回顾性分析,结合文献进行cNO期甲状腺乳头状腺癌颈淋巴结清扫手术适应症探讨.结果 95例cNO者中pNO者46例(48.4%),pN阳性者49例(51.6%).病史＜2年者59例(62.1%),其中pNO者39例(66.1%),仅Ⅵ区淋巴结阳性者15例(25.4%),Ⅱ-Ⅵ区淋巴结阳性者5例(8.5%),病史≥2年者36例(37.9%),其中pNO者7例(19.4%),仅Ⅵ区淋巴结阳性者14例(38.9%),Ⅱ～Ⅵ区淋巴结阳性者15例(41.7%),67例cN阳性者中pNO者6例(9.0%),pN阳性者61例(91.0%).结论对cN阳性的甲状腺乳头状腺癌患者应常规行颈淋巴结清扫手术治疗.将Ⅵ区淋巴结按原发灶处理较为合理.对于一些边远地区、经济、医疗条件较差、不能定期复查且病史≥2年的cNO患者可行颈选择性淋巴结清扫.

Research of surgical neck lymph nodes clearance for the patients with papillary thyroid carcinoma at the stage of cNO

Objective To discuss the condition of preventive surgical neck lymph nodes clearance for the patients with papillary thyroid cancer at the stage of cN_O. Methods Review and analyze 162 cases with papillary thyroid cancer that had undergone neck lymph nodes clearance, and explore the surgical treatment of lymph nodes clearance for the patients with papillary thyroid cancer at the stage of cN_O. Results Among 95 cN_O cases, 46 cases are pN_O (48.4%),49 cases are pN positive (51.6%). 59 cases, their medical history was less than 2 years, and in these cases,39 cases were pN_O(66.1%),15 cases only the 6th area lymph nodes were positive (25.4%),5 cases second to 6th area lymph nodes positive (8.5%),36 cases medical history were 2 years or more than 2 years, and among these cases,7 cases were pN_O (19.4%),14 cases only 6th area lymph node positive(38.9%),15 cases were second to 6th area lymph nodes positive(41.7%).Among 67 cases with cN positive,6 cases were pN_O(9.0%),61 cases were pN positive(91.0%).Conclusion Treating lymph nodes in 6th area as original disease is reasonable. Patients with papillary thyroid cancer and cN positive should be routinely treated with surgical neck lymph nodes clearance. For those patients at the stage of cN_O who are in remote areas or their economic condition is poor or the local area medical condition, they can not be checked up regular, and their medical history is more than 2 years, should be given preventive surgical neck lymph node clearance.