Ⅵ区淋巴结在甲状腺乳头状癌颈淋巴转移中的意义  

Role of level Ⅵ lymph nodes metastasis in cervical metastasis of patients with papillary thyroid cancer

作　　者：边学[1] 陈辉[2] 叶星[1] 唐平章[3] 

机构地区：[1]北京军区总医院,100700 [2]南京军区福州总医院 [3]中国医学科学院北京协和医学院肿瘤医院头颈外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第8期664-668,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 进一步认识Ⅵ区淋巴结在甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈转移中的地位及PTC患者颈部转移淋巴结的分布特点,为PTC的颈部淋巴结处理提供依据.方法 回顾性总结2002年1月至2004年12月97例病变局限于一侧腺叶的PTC患者的临床资料：72例术前检查为cNO,25例为cN＋;32例原发灶长径≤1 cm,65例原发灶长径＞1 cm.术中常规取Ⅲ、Ⅳ区淋巴结做冰冻病理检查,根据淋巴结病理结果、肿瘤原发灶大小及位置决定颈部淋巴结的清扫范围.Ⅲ、Ⅳ区淋巴转移患者行包括Ⅵ区的改良性颈清扫;伴有肿瘤包膜外侵患者行双侧Ⅵ区清扫;原发灶长径≤1 cm行患侧Ⅵ区清扫;原发灶长径＞1 cm行双侧Ⅵ区清扫.结果 97例患者行Ⅵ区清扫122侧,45.1%（55/122）发生淋巴转移.72例cN0患者45.8%（33/72）发生Ⅵ区淋巴转移,25例cN＋患者76.0%（19/25）发生Ⅵ区淋巴转移,差异有统计学意义（x2=6.790,P=0.009）.10例原发灶包膜外侵患者的淋巴转移发生率为65.0%（13/20）,87例无包膜外侵患者的淋巴转移发生率为41.2%（42/102）,差异有统计学意义（x2=3.833,P=0.047）.32例原发灶长径≤1 cm的患者行患侧Ⅵ区清扫,43.8%（14/32）发生淋巴转移,65例原发灶长径＞1 cm患者行双侧Ⅵ区清扫,69.2%（45/65）有患侧Ⅵ区转移,23.1%（15/65）有双侧Ⅵ区转移,两组间同侧Ⅵ区转移率的差异有统计学意义（x2=5.843,P=0.016）.结论 Ⅵ区为FTC较早发生淋巴转移的区域,伴有原发灶包膜外侵犯者易发生Ⅵ区淋巴转移.原发灶长径≤1 cm的患者可发生同侧Ⅵ区转移;原发灶长径＞1 cm者可发生双侧Ⅵ区转移.PTC颈淋巴转移可单独或同时发生在Ⅵ区或侧颈区的任何一个区域.术中应常规做Ⅲ、Ⅳ区淋巴结冰冻病理检查,淋巴结阳性者行包括Ⅵ区的改良性颈清扫.Objective To study the features of level Ⅵ lymph node metastasis in papillary thyroid cancer （PTC） and the distribution of metastastic lymph nodes in the neck levels, and to provide evidences for the treatments of cervical metastasis in patients with PTC. Methods Ninety-seven PTC cases were reviewed retrospectively. The tumors in all cases were limited to one side lobe. Of them, 72 patients were cN0 and 25 patients were cN ＋; 32 patients with tumors ≤ 1 cm and 65 patients with tumors ＞ 1 cm.Pathological examinations of frozen biopsies of level Ⅲ and Ⅳ lymph nodes were taken in the operation. The extent of lymph node dissection depending on pathological examination results of level Ⅲ and Ⅳ lymph nodes and the size and location of the tumor. For the patients with metastastic lymph nodes in level Ⅲ and Ⅳ, the modified neck dissection including level Ⅵ was performed. Ipsilateral Ⅵ lymph node dissection was performed for the patients with tumors ≤ 1 cm and bilateral Ⅵ lymph node dissection for the patients with tumors ＞ 1 cm or with extra-thyroidal invasion. Results In 97 patients, 122 sides of Ⅵ lymph node dissection were performed. Positive nodes in level Ⅵ were found in 45.1% （55/122） patients. The positive rates of nodes metastases in level Ⅵ were 45.8% （33/72）for 72 patients with cN0 and 76.0% （ 19/25 ） for 25 patients with cN ＋ respectively, with a significant difference statistically （ x2 = 6.790, P = 0.009 ）.Positive rates of node metastases in level Ⅵ were 65.0% （ 13/20 ） in 10 patients with extra-thyroidal invasion and 41.2% （42/102） in 77 patients without extra-thyroidal invasion respectively, with a significant difference statistically （x2 = 3.833, P = 0.047 ）. Positive rate of node metastasis in level Ⅵ was 43.8%（14/32） in 32 patients with tumors≤1cm. Of 65 patients with tumors ＞ 1cm, ipsilateral and bilateral node metastasis rates were 69.2% （45/65） and 23.1% （15/65） respectively, with a significant difference stati

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 颈淋巴结清扫术 活组织检查 

分 类 号：R736.1[医药卫生—肿瘤]