喉返神经入喉处淋巴结对于甲状腺乳头状癌中央区淋巴结清扫的重要性

目的 探讨喉返神经入喉处淋巴结转移在甲状腺乳头状癌手术诊治中的临床意义。方法 对2016年4月至11月接受手术治疗的598例甲状腺乳头状癌病人的临床资料进行临床研究。在中央区淋巴结清扫术中,探查喉返神经入喉处淋巴结,并采用纳米活性炭进行辅助示踪。将入喉处淋巴结与中央区其他淋巴结进行病理检查,并观察术后并发症发生情况。结果 喉返神经入喉处淋巴结检出率为 5.85%(35/598) ,肿瘤转移率为2.51%。该处淋巴结检出中,15例有转移,20例未转移。该处淋巴结转移与多种危险因素有关,包括肿瘤直径、位置和数量,肿瘤数量为其独立影响因素。该处淋巴结阳性病人中,石蜡病理检查证实伴有其他中央区淋巴结转移14例（93.3%）。7例（1.2%）发生术后近期并发症。结论 甲状腺乳头状癌可能发生喉返神经入喉处淋巴结转移。完整的中央区淋巴结清扫术应清扫喉返神经入喉处区域淋巴结。

Clinical importance of recurrent laryngeal nerve lymph nodes at entrance point in central lymph node dissection for papillary thyroid carcinoma

Objective To explore the clinical significance of metastasis to recurrent laryngeal nerve lymph nodes at entrance point (RLNLN-ep) in the patients with papillary thyroid carcinoma (PTC). Methods An analysis was done inclu-ding 598 consecutive patients with PTC who underwent thyroid surgery from April 2016 to November 2016. We explored RLNLN-ep in central compartment lymph node dissection. Carbon nanoparticles were injected into the lobes to help identify lymph nodes. RLNLN-ep and the other central compartment lymph nodes were sent for pathological examination. The complications were recorded. Results RLNLN-ep was found in 35 of 598 (5.85%) cases. There were 15 (2.51%) cases with metastasis of PTC and 20 cases without the metastasis. The metastasis rate of RLNLN-ep was related to tumor diameter, tumor location and the amount of tumor. The amount of tumor was an independent factor of metastasis of RLNLN-ep. There were 14 (93.3%) cases with metastasis of RLNLN-ep who were found the other central compartment lymph node metastasis simultaneously. Seven (1.2%) cases had morbidity postoperatively. Conclusions RLNLN-ep could be the site of metastasis of PTC. Central compartment lymph node dissection should include RLNLN-ep and the surrounding tissue.