微小乳头状甲状腺癌行颈淋巴结清扫术的必要性探讨  

Study on the necessity of neck dissection for papillary thyroid microcarcinoma

作　　者：裴雷[1] 陈干农[1] 周恩相[1] 谢萍芳[1] 唐中华[1] 

机构地区：[1]中南大学湘雅二医院乳腺甲状腺外科,湖南长沙410011

出　　处：《中国普通外科杂志》2011年第5期443-445,共3页China Journal of General Surgery

摘　　要：目的探讨微小乳头状甲状腺癌手术行颈部淋巴结清扫术的必要性。方法分析1999年5月—2009年10月收治的微小乳头状甲状腺癌手术患者的临床病理资料。分为单发灶组(42例)和多发灶组(27例),均行中央组(Ⅵ区)、同侧或双侧颈深组(Ⅲ+Ⅳ区)淋巴结清扫术。结果Ⅵ区淋巴结转移发生率单发灶组与多灶组分别为2例(4.8%)与7例(25.9%),Ⅲ+Ⅳ区淋巴结转移发生率单发灶组与多发灶组分别为0例(0)与3例(11.1%)。两组Ⅵ,Ⅲ+Ⅳ区淋巴结转移率差异具有统计学意义(P<0.05)。术后4例发生一过性低钙血症,3例短暂性喉返神经麻痹,1例淋巴瘘,1例多灶组术后7个月复发,1例单灶组术后42个月复发。无1例死亡病例。结论多发灶性的微小癌应积极施行淋巴结清扫;单发灶性微小癌可在定期随诊观察下暂不行预防性的颈淋巴结清扫术,既不会影响患者的生存率又能提高生存质量。Objective To evaluate the necessity of neck dissection for papillary thyroid microcarcinoma.Methods The clinicopathologic data of 69 patients with papillary thyroid microcarcinoma treated in our hospital from May 1999 to October 2009 were analyzed.Of the patients,42 cases were unifocal and 27 cases were multifocal.All patients underwent thyroidectomy and central compartment（level Ⅵ） and ipsilateral or bilateral deep lymph nodes（levels Ⅲ and Ⅳ） dissection.Results In patients of unifocal and multifocal tumor,the metastasis of central compartment lymph nodes was found in 2（4.8%） and 7（25.9%） cases,and of deep lymph nodes was in 0（0） and 3（11.1%） cases,respectively.The metastasis rates of central compartment and deep lymph nodes were both significantly different between patients with unifocal and multifocal tumor（both P0.05）.Four cases of temporary hypocalcemia,three cases of temporary recurrent laryngeal nerve paralysis and one case of lymphatic fistula occurred postoperatively.Recurrence occurred in one unifocal case 42 months later and one multifocal case 7 months later.No death occurred during the follow-up period of all patients.Conclusions Neck dissection should be aggressively performed in patients with multifocal papillary thyroid microcarcinoma.However,prophylactic neck dissection is not necessary for unifocal cases under regularly follow-up care,because that has no influence on the survival rate but can improve quality of life.

关 键 词：甲状腺肿瘤/外科学 微小癌 淋巴结转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]