临床N0期甲状腺乳头状癌颈部淋巴结隐匿性转移规律的分析  

Analysis of the pattern of occult cervical lymphatic metastasis in N0 papillary thyroid carcinoma

作　　者：李涛[1] 傅丽兰[1] 刘子文[2] 

机构地区：[1]北京协和医学院,临床医学专业北京100005 [2]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《基础医学与临床》2014年第8期1071-1075,共5页Basic and Clinical Medicine

摘　　要：目的探讨临床N0期甲状腺乳头状癌(c N0 PTC)的颈部淋巴结转移规律,为c N0 PTC预防性淋巴结清扫范围提供循证医学证据。方法检索Pub Med、Embase、Cochrane和Medline等数据库,纳入行甲状腺切除和淋巴结清扫的c N0 PTC病例。以Stata10.2进行分析。结果共纳入6项研究(4 154例c N0 PTC)。中央组淋巴结转移率57%,侧方淋巴结转移率40%,各颈部淋巴结分区淋巴结转移率从高到低依次为Ⅵ区(57%)、Ⅲ区(42%)、Ⅳ区(21%)、Ⅱ区(10%)、Ⅴ区(6%)、Ⅶ区(2%)、Ⅰ区(2%)。结论预防性淋巴结清扫,需同时清扫Ⅵ区、Ⅲ区和Ⅳ区。Objective To find pattern of lymphatic metastasis in NO stage （cN0） papillary thyroid carcinoma （PTC） through an analysis of published studies to establish evidence-based guidelines for selecting and delineating clinical target level of prophylactic lymphadenectomy. Methods The PubMed, Embase, Cochrane, and Medline databases were searched for relevant articles. The patients included were mainly untreated cN0 PTC cases that underwent thyroidectomy and prophylactic lymphadenectomy. The data were analyzed by Stata 10. 2. Results A literature search yielded 6 reports. 57% of the cN0 PTC cases presented with central compartment metastasis, and 40% presented with lateral compartment metastasis. The most commonly involved regions include level VI and level m, with lymphatic metastasis rates of 57% and 42%, respectively, followed by level IV, level Ⅱ , level V, level VH, and level I, with metastasis rates of 21%, 10%, 6%, 2%, and 2%, respectively. Conclusions Clearance of level Ⅵ, level Ⅲ and level IV during prophylactic neck dissection is essential for the complete removal of occult metastatic lymph nodes.

关 键 词：甲状腺乳头状癌 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]