甲状腺乳头状癌颈部淋巴结转移规律及其治疗方案选择的研究  

Characteristics of node metastases for clinically node-negative patients with papillary thyroid carcinoma

作　　者：边学[1] 陈辉[2] 叶星[1] 

机构地区：[1]北京军区总医院耳鼻咽喉头颈外科,北京100700 [2]南京军区福州总医院耳鼻咽喉头颈外科,福建福州350025

出　　处：《中华肿瘤防治杂志》2011年第15期1189-1191,1194,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨临床淋巴结阴性的甲状腺乳头状癌患者的颈部淋巴结转移特点及淋巴结处理方法。方法:回顾性分析107例临床淋巴结阴性甲状腺乳头状癌患者的临床资料。按肿瘤大小及淋巴结的处理不同将患者分为3组,A组:肿瘤长径≤1cm行同侧Ⅵ区淋巴结清除;B组:肿瘤长径>1～3cm行双侧Ⅵ区淋巴结清除及同侧Ⅲ、Ⅳ区淋巴结冷冻病理;C组:肿瘤长径>3cm者行双侧Ⅵ区淋巴结清除及同侧Ⅲ、Ⅳ区淋巴结冷冻病理。B、C组患者中,同侧Ⅲ、Ⅳ区淋巴结冷冻病理转移者行改良性颈淋巴结清除。结果:3组患者同侧Ⅵ区转移率分别为41.1%、61.1%和73.3%,差异有统计学意义,χ2=6.610 9,P=0.036 7;B、C组患者的对侧Ⅵ区淋巴结转移率分别为30.5%和73.3%,差异有统计学意义,χ2=3.851 0,P=0.049 7;B、C组患者的Ⅲ、Ⅳ区转移率分别为19.4%和46.7%,差异有统计学意义,χ2=4.267 4,P=0.038 9。结论:临床淋巴结阴性的甲状腺乳头状癌患者易发生Ⅵ及Ⅲ、Ⅳ区淋巴结转移。肿瘤长径≤1cm者建议行同侧Ⅵ区淋巴结清除,肿瘤长径>1cm者建议行双侧Ⅵ区淋巴结清除及同侧Ⅲ、Ⅳ区淋巴结冷冻,转移者行改良性颈淋巴结清除。OBJECTIVE： To determine the characteristics of cer- vical lymph node metastases for clinically node-negative patients with papillary thyroid cancer and explore treatment for affected lymph nodes. MESTHODS： Retrospective chart review of 107 clinically nodenegative thyroid papillary carcinoma patients was performed. According to the size of tumor and treatment to the lymph node, patients were divided into 3 groups. Group A： tumor diameter ≤ 1 cm and lymph node dissection in ipsilateral level Ⅵ ; Group B： tumor diameter 〈 1- 3 cm and bilateral lymph node dissection in level gI with level ipsilateral Ⅲ, Ⅳ lymph nodes removed for pathology examination; Group C： tumor diameter 〉3 cm and bilateral lymph node dissection in level Ⅵ with level ipsilateral Ⅲ, Ⅳ lymph nodes removed for pathology examination. Metastasized cases underwent modified neck dissection. RESULTS： The rates of metastasis to the ipsilateral level Ⅵ were 41.1%, 61.1% and 73.3% for A,B,C groups respectively. The difference in the three groups was statistically significant （χ2 = 6. 610 9,P=0. 036 7）. The rates of metastasis to the contralateral level Ⅵ were 30.5 % and 73.3 % in group B and group C. The difference was statistically significant（x2 = 3. 851 0, P： 0. 049 7）. The rates of metastasis to the level Ⅲ,Ⅳ in group B and group C were 19.4% and 46.7% respectively. The difference was statistically significant （Ze= 4. 267 4,P 0. 038 9）. CONLUS1ONS： Patients with clinically node- negative papillary thyroid cancer are prone to lymph node metastasis at level Ⅲ,Ⅳ and Ⅵ. Patients with tumor diameter ≤1 cm should un dergo an anipsilateral level Ⅵ dissection. Patients with tumor diameter 〉 1 cm should undergo both bilateral level Ⅵ dissection and an ipsilat eral level Ⅲ,Ⅳ lymph nodes frozen pathology examination. Level Ⅲ,Ⅳ metastasized cases should undergo modified neck dissection.

关 键 词：甲状腺肿瘤/外科学 淋巴结转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]