颈中央区域淋巴结清扫在临床颈淋巴结阴性甲状腺乳头状癌手术治疗中的应用  

Application of Central Lymph Node Dissection to Surgical Operation for Clinical Stage N0 Papillary Thyroid Carcinoma

作　　者：胡薇[1] 施俊义[1] 盛湲[1] 李莉[1] 

机构地区：[1]第二军医大学附属长海医院普四科,上海200433

出　　处：《癌症》2008年第3期304-306,共3页Chinese Journal of Cancer

摘　　要：背景与目的:对临床已证实颈部淋巴结阳性(cN+)甲状腺乳头状癌患者行联合根治术已无异议,但对临床颈淋巴结阴性(cN0)患者是否实行选择性颈淋巴结清扫,以及清扫范围、清扫时机等国内外均存在争议。本研究探讨cN0甲状腺乳头状癌患者手术颈部淋巴结处理的恰当方案。方法:2005年至2006年84例经术前常规B超、选择性颈部MRI检查确定为cN0甲状腺乳头状癌患者,随机分为A、B两组,各42例。A组行原发灶根治+常规同侧中央区域淋巴结清扫术;B组仅行原发灶根治术。术后均服甲状腺素内分泌治疗。结果:A组淋巴结检出率平均3枚/例,淋巴结转移率47.62%。两组在术后并发症发生率差异无统计学意义(P<0.05)。结论:原发灶根治+同侧中央区域淋巴结清扫是治疗cN0甲状腺乳头状癌的一种值得推荐的术式,在不造成额外损伤的基础上超越了单纯原发灶的治疗,具有前哨淋巴结活检的意义,还可避免再次颈淋巴结清扫时对喉返神经的损伤。BACKGROUND ＆ OBJECTIVE： The treatment for papillary thyroid carcinoma （PTC） without cervical lymph node metastasis （cN0） is controversial. This study was to explore a suitable method to dissect cervical lymph nodes for stage cN0 PTC patients. METHODS. Eighty-four stage cN0 PTC patients, diagnosed by B ultrasound or cervical MRI from 2005-2006, were randomly divided into two groups. Thyroidectomy and ipsilateral central lymph node dissection were performed in Group A, while only thyroidectomy was performed in Group B. Each group contained 42 patients. Both groups took thyroxin tablets after operation. RESULTS： An average of 3 lymph nodes were found in each case of Group A, and the lymph node metastasis rate was 47.62%. The occurrence rates of complications were not significantly different between the two groups（P〈0.05）. CONCLUSIONS： Thyroidectomy plus ipsilateral central lymph node dissection is recommended for the treatment of stage cN0 PTC. It can also avoid damage of recurrent laryngeal nerve in re-dissection.

关 键 词：甲状腺肿瘤 甲状腺乳头状癌 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]