选择性中央区淋巴结清扫治疗cNO甲状腺乳头状癌的临床价值

目的探讨选择性中央区淋巴结清扫术在临床颈淋巴结阴性（cN0）的甲状腺乳头状癌患者中的治疗价值。方法回顾性分析中国医科大学附属第一医院2007年1月至2011年12月期间收治的326例cN0甲状腺乳头状癌患者的临床资料，并对影响中央区淋巴结转移的相关因素进行分析。结果本组326例cN0甲状腺乳头状癌患者的中央区淋巴结转移率为35．89％（117／326）。年龄在〈45岁、肿瘤直径〉1cm及原发灶浸润包膜的cN0甲状腺乳头状癌患者的淋巴结转移率明显高于年龄≥45岁、肿瘤直径≤1cm及原发灶未浸润包膜的oN0甲状腺乳头状癌患者（年龄：46．56％比28．72％，P=0．001；肿瘤直径：44．44％比26．45％，P=0．001；包膜浸润：50．00％比33．09％，P=0．020）。进一步的多因素分析显示，年龄〈45岁和肿瘤直径〉1cm是cN0甲状腺乳头状癌中央区淋巴结转移的独立危险因素（P〈0。05）。术后6例出现暂时性喉返神经损伤，18例并发暂时性甲状旁腺功能低下，4例出现暂时性喉上神经损伤，1例并发急性喉头水肿，无永久性喉神经损伤、甲状旁腺功能低下等并发症发生。术后266例（81．60％）获得随访，随访7～67个月（平均31．2个月），有3例发生侧颈区淋巴结转移。结论cN0甲状腺乳头状癌行选择性中央区淋巴结清扫术是必要的、安全的处理方式，建议对cN0甲状腺乳头状癌常规行患侧中央区淋巴结清扫术，特别是年龄〈45岁和肿瘤直径〉1cm的cN0甲状腺乳头状癌患者。

Clinical Value of Elective Central Compartment Lymph Node Dissection for cNO Papillary Thyroid Carcinoma

Objective To investigate the clinical value of elective central compartment lymph node dissection for cN0 papillary thyroid carcinoma. Method The clinical data of 326 patients with cN0 papillary thyroid carcinoma from January 2007 to December 2011 in this hospital were analyzed retrospectively. Results The lymph node metastasis incidence was 35.89% （117/326） in 326 patients with cN0 papillary thyroid carcinoma, which in the patients with age 〈 45 years, tumor diameter 〉1 cm, and thyroidal tumor infiltrated envelope were significantly higher than those in the pati- ents with age 〉t 45 years, tumor diameter 〈~ 1 cm, and thyroidal tumor not-infiltrated envelope （age： 46. 56% versus 28.72%, P=0. 001 ; tumor diameter： 44. 44% versus 26.45%, P=0. 001 ; infiltrated envelope： 50. 00% versus 33.09%, P=0. 020）. Multivariate analysis showed that age 〈45 years and tumor diameter 〉 l cm were independent risk factors for central compartment lymph node metastasis of cN0 papillary thyroid carcinoma. There were 6 cases of temporary recu- rrent laryngeal nerve injury, 18 cases of temporary hypoparathyroidism, 4 cases of temporary superior laryngeal nerve injury, and 1 case of acute caryngeal edema. There were no complications such as permanent laryngeal nerve injury andpermanent hypoparathyroidism. Three cases had lateral cervical lymph node metastases during a follow-up of 7-67 months （mean 3 i. 2 months）. Conclusions It is necessary and safe to perform elective central compartment lymph node dissec- tion for cN0 papillary thyroid carcinoma. The elective central compartment lymph node dissection should be considered in patients with cN0 papillary thyroid carcinoma, especially in patients with age of 〈45 years and tumor diameter 〉 1 cm.