甲状腺乳头状癌颈部淋巴结转移规律的临床分析

目的 探讨甲状腺乳头状癌颈淋巴结转移规律,为选择最佳手术方式提供参考。方法 回顾分析2001年1月至2013年8月济南军区总医院甲状腺乳腺外科616例诊断为甲状腺乳头状癌患者的临床和病理资料。结果 616例有完整统计资料的甲状腺乳头状癌患者中，病理诊断颈部淋巴结总转移率为58.77%(362/616)，中央区(Ⅵ区)淋巴结转移率为48.70%(300/616)，颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)淋巴结转移率为38.80%(239/616)，原发肿瘤的部位、最大直径、是否累及包膜、是否为多发病灶及患者年龄对颈部淋巴结转移率有显著影响，差异有统计学意义(P＜0.05)，且双因素方差分析显示，肿瘤直径越大，转移到颈侧区的可能性越大。结论 甲状腺乳头状癌最常见的转移部位是Ⅵ区，术中应常规清除，其次依次为Ⅲ、Ⅳ、Ⅱ、Ⅴ区，对于患者原发肿瘤具有累及包膜、直径＞1cm、多发病灶及位于双侧等特点应清扫颈侧区，术中快速病理检查颈侧区淋巴结病理状态，确定颈侧区淋巴结清扫范围。

Regularity of lymph node metastasis in papillary thyroid carcinoma

Objective To explore the regularity of cervical lymph node metastasis of papillary thyroid carcinoma and to select an appropriate surgical method for papillary thyroid carcinoma. Methods The clinical data of 616 cases of papillary thyroid carcinoma treated in this hospital between January 2001 and August 2013 were retrospectively analyzed. Results The total lymph node metastasis rate was 58.77% (362/616). The lymph node metastasis rate was 48.70% (300/616) in level Ⅵ and was 38.80% (239/616) in level Ⅱ, Ⅲ, Ⅳ and Ⅴ. There was significant relationship between the site of the original tumor, maximum diameter, amicula invasion, multifocality, age of patients and cervical lymph node metastasis (P＜0.05). Conclusion Lymph nodes of level Ⅵ should routinely be dissected in the first surgery in patients with thyroid papillary carcinoma. When the tumor is invaded to amicula, or whose diameter is ＞1.0cm or is multifocality, the cervical lymph node should be dissected and frozen biopsy should be made in the operations to determine the extend of lymphadenectomy.