择区性颈淋巴结清扫术在临床颈淋巴结阴性甲状腺癌患者中的应用  

Significance of selective neck dissection in patients with cN0 thyroid carcinoma

作　　者：李正江[1] 安常明[1] 鄢丹桂[1] 张溪微[1] 张宗敏[1] 徐震纲[1] 唐平章[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所头颈外科,100021

出　　处：《中华肿瘤杂志》2013年第10期783-786,共4页Chinese Journal of Oncology

基　　金：北京希望马拉松专项基金（LC2011A13）

摘　　要：目的 探讨择区性颈淋巴结清扫术在颈部高危临床颈淋巴结阴性（cN0）甲状腺癌患者中的应用价值.方法 前瞻性分析2006年8月至2011年6月,中国医学科学院肿瘤医院头颈外科收治的63例颈部高危cN0甲状腺癌患者的临床资料.结果 63例患者均经病理证实为甲状腺乳头状癌,侧颈淋巴结隐性转移率为39.7％.单因素分析结果显示,63例患者术后病理检查甲状腺被膜侵犯患者的侧颈淋巴结隐性转移率为46.9％,而甲状腺被膜未侵犯患者的侧颈淋巴结隐性转移率为14.3％,差异有统计学意义（P=0.028）.Ⅵ区淋巴结转移患者的侧颈淋巴结隐性转移率为54.3％,而Ⅵ区淋巴结阴性患者的侧颈淋巴结隐性转移率为21.4％,差异有统计学意义（P=0.008）.原发灶肿瘤≥2 cm患者的侧颈淋巴结隐性转移率为41.4％,而原发灶肿瘤＜2 cm患者的侧颈淋巴结隐性转移率为38.2％ （P =0.803）.术前超声检查发现侧颈淋巴结肿大,但不考虑转移的34例患者中,17例出现隐性淋巴结转移,转移率为50.0％,而侧颈淋巴结术前超声检查阴性患者的隐性淋巴结转移率为27.6％ （P =0.072）.多因素Logistic回归分析结果显示,仅Ⅵ区淋巴结转移与侧颈淋巴结隐性转移有关（P=0.017）.而原发灶肿瘤被膜侵犯、原发肿瘤大小和术前超声检查侧颈淋巴结状态与侧颈淋巴结隐性转移无关（均P ＞0.05）.结论 择区性颈淋巴结清扫术对颈部高危的cN0甲状腺癌患者是可行的,能及时发现和清除侧颈隐性淋巴结的转移.建议对甲状腺被膜侵犯和Ⅵ区淋巴结转移的cN0甲状腺癌患者,常规行颈部Ⅲ、Ⅳ区淋巴结清扫.Objective To investigate the significance of selective neck dissection in patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis. Methods Sixty three patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis were prospectively studied at the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2006 and June 2011. The patients with cN0 thyroid carcinoma easy to occur neck lymph node metastasis include ： The maximum diameter of primary tumor is ≥2 cm; The primary tumor invaded the thyroid capsule; Lymph node metastasis in level Ⅵ is found; Lymph node enlargement in level Ⅲ or/and IV were detected preoperatively by ultrasonography, but not considered as metastasis. The surgical procedure is that the selective neck dissection in level Ⅲ and Ⅳ is performed depending on the collar incision of thyroid surgery. The lymph node chosen from the specimen has a frozen section. If lymph node metastasis is found in the frozen section, a functional neck dissection should be performed through prolonging the collar incision. Results All cases were pathologically confirmed as thyroid papillary carcinoma. The occult metastasis rate of lateral neck lymph nodes was 39.7%. According to the univariate analysis, the patients with thyroid capsule invasion and lymph node metastasis in level VI were more likely to have lateral neck lymph node metastasis, and the occult metastasis rate was 46.9% and 54.3%, respectively （P = 0. 028, P = 0. 008）, and there were statistically no significantdifference in the primary tumor size and the preoperative neck lymph node status by ultrasonography with occult metastasis of lateral neck lymph nodes （ P = 0. 803 and P = 0. 072 ）. According to the multivariate analysis, there was a significant correlation only between the lymph node metastasis in level VI and occult metastasis of lateral neck lymph nodes （ P = 0. 017 ）, but

关 键 词：甲状腺肿瘤 择区性颈淋巴清扫术 临床颈淋巴结阴性 

分 类 号：R736.1[医药卫生—肿瘤]