分化型甲状腺癌的颈淋巴转移规律

目的探讨分化型甲状腺癌颈部淋巴转移的规律及临床阳性淋巴结（cN＋）的颈部治疗模式；评价术前彩超在诊断甲状腺癌颈转移中的作用。方法回顾性分析我院2003年7月-2005年7月诊治93例（113侧）cN＋分化型甲状腺癌患者的临床资料，分为术前颈部淋巴结触诊阳性患者（64侧）和术前颈部触诊阴性，彩超诊断为颈淋巴转移患者（49侧）两组。记录术后颈清扫标本中转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布。结果93例患者中双侧颈转移占21．5％（20／93），113侧颈清扫标本中92侧（81．4％）为多分区转移；转移淋巴结在颈部的分布以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主，分别为60．2％（68／113）、70．8％（80／113）、61．9％（70／113）、58．4％（66／113）；Ⅴ区较少分布22．1％（25／113），差异有统计学意义（χ^2=64．597，P〈0．001）。颈部触诊阳性患者颈清扫标本中转移淋巴结数量（10．1个），多于颈触诊阴性、彩超检查阳性患者（6．9个）；淋巴转移区域也多于后者（3．18区与2．61区）；术前彩超检查可以发现43．4％（49／113）的颈部触诊漏诊的颈部淋巴转移。结论分化型甲状腺癌的颈部淋巴转移为多分区分布，Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位；彩超在甲状腺癌颈淋巴转移的诊断中具有重要的价值；对cN＋的分化型甲状腺癌患者，应进行包括Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的改良性颈清扫术。

Distribution of cervical lymph node metastasis in well-differentiated thyroid carcinoma

Objective To study the distribution of cervical lymph nodes metastases in patients with differentiated thyroid carcinoma, explore the surgical modality of the neck of cN + cervical node metastasis and evaluate the role of preoperative ultrasonography in detecting of cervical metastases of differentiated thyroid carcinoma. Methods Data were reviewed retrospectively from medical records between July 2003 and July 2005, in which 93 patients (113 sides) of differentiated thyroid carcinoma patients with cN + cervical lymph nodes metastasis. Patients were divided into 2 groups: group 1, 64 cervical sides with preoperative palpable cervical lymph nodes; group 2, 49 cervical sides with impalpable node but preoperative ultrasonic positive nodal metastasis. All the pathologic specimens were reviewed by pathologists counting the numbers of pathologic positive nodes and mapping localization of positive nodes in level II , III , IV, V and VI respectively. Results In 93 patients 21. 5% (20/93 ) of those metastasize bilaterally. In those 113 sides specimens 92 sides (81. 4% ) involved multi-sites in the neck. The distribution of metastasized nodes were; level II , 60.2% (68/113) ; level III, 70. 8% (80/113); level IV,61.9% (70/113) ; level VI, 58.4% (66/113) ; level V ,22. 5% (25/113). The numbers of positive nodes of group 1 were more than the number of group 2(10.1 vs6.9) and the involved levels of group 1 was also more than the levels of group 2 (3. 18 level vs 2. 61 level). Preoperative ultrasonography could detect 43. 4% (49/113 ) of lymph nodes metastasis that were missed by palpation in the physical examination. Conclusions The distribution of the cervical nodes in patients with differentiated thyroid carcinoma were multi-levels in the neck and mainly localized in level II , level III , level IV and level VI. Preoperative ultrasonograpy is a mainstay in detecting of cervical lymph nodes metastasis in thyroid cancer. For patients with differentiated thyroid carcinoma of cN + cervical lymph nodes should be undergone modified neck dissection, includes level II , III , IV,V,VI.