临床NO单侧结节甲状腺乳头状癌Ⅵ区各亚区淋巴结转移相关因素分析  

Factors related to central lymph node metastasis in different subregions for unilateral papillary thyroid carcinoma with clinical N0 stage

作　　者：张亚冰[1] 张彬[1] 万汉锋[1] 鄢丹桂[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：《中华耳鼻咽喉头颈外科杂志》2014年第10期807-811,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 分析影响临床N0（cN0）单侧结节甲状腺乳头状癌（papillary thyroid carcinoma,PTC）患者Ⅵ区各亚区淋巴结转移的临床和病理因素.方法 回顾性分析中国医学科学院肿瘤医院头颈外科同一治疗小组2011年1月至2014年1月间行甲状腺癌手术术后病理确诊为PTC的145例cN0单侧结节初治患者的临床资料.145例患者颈部Ⅵ区淋巴结分亚区送检,分析患者年龄、性别、肿瘤最大径、多灶与否、被膜侵犯等因素与各亚区淋巴结转移的相关性.结果 84例（57.9％）患者存在Ⅵ区转移,各亚区中同侧气管旁淋巴结转移最常见（78例,53.8％）,其次为气管前（35例,24.1％）、喉前（8例,11.3％）.其中右侧气管旁淋巴转移分为喉返神经前转移（17/38,44.7％）和喉返神经后转移（12/38,31.6％）.同侧气管旁淋巴结转移的危险因素如下：肿瘤最大径＞1 cm（OR=2.17,95％ CI为1.06 ～4.45,P=0.034）及被膜受侵（OR=4.49,95％ CI为1.80～11.20,P=0.001）;气管前淋巴结转移的危险因素为同侧气管旁淋巴结转移（OR =2.12,95％ CI为0.08 ～4.60,P=0.003）.结论 cN0 PTC患者发生Ⅵ区淋巴结转移的风险仍较高,其中同侧气管旁亚区最易累及.对于肿瘤最大径＞1 cm和/或被膜受侵者建议行同侧气管旁＋气管前＋喉前淋巴清扫,右侧气管旁淋巴清扫应当同时包括喉返神经前和喉返神经后淋巴结.多癌灶者则应积极采取甲状腺全切除＋对侧气管旁淋巴清扫的术式进行治疗.Objective To study clinicopathologic factors related to central lymph node （CLN） metastasis in different subregions for unilateral papillary thyroid carcinoma （PTC） with clinical N0.Methods A total of 145 PTC cases with clinical N0 treated in the same group of the department of head and neck surgery,Cancer Hospital,Chinese Academy of Medical Science between Jan.2011 and Jan.2014 was analysed retrospectively.Clinicopathologic factors related to CLN metastasis in different subregions were analyzed,including sex,age,tumor size,extrathyroidal extension,and multifocal tumor.Results CLN metastases existed in 57.9% （84/145） cases and the incidences of ipsilateral paratracheal,pretracheal,and prelaryngeal metastasis were 53.8%,24.1% and 11.3% respectively.Right paratracheal lymph node metastasis occurred in anterior （17/38,44.7%）and posterior（12/38,31.6%） to the recurrent laryngeal nerve.Multivariate analysis indicated that extrathyroidal extension（OR =4.49,95% CI 1.80-11.20,P =0.001） and tumor size （OR =2.17,95% CI 1.06-4.45,P =0.034） were independent risk factors for ipsilateral paratracheal CLN metastasis ;ipsilateral paratracheal CLN metastasis（OR =2.12,95% CI 0.08-4.60,P =0.003） was an independent risk factor for pretracheal CLN metastasis.Conclusions A high risk of CLN metastasis especially ipsilateral paratracheal metastasis exists in DTC with clinical N0.Ipsilateral paratracheal,pretracheal and prelaryngeal CLN dissection should be conducted when maximum tumor diameter more than 1 cm or extrathyroidal extension.CLN anterior and posterior to the recurrent larygeal nerve should be removed simultaneously when the ipsilateral paratracheal CLN metastasis at right side.Total thyroidectomy and contralateral paratracheal CLN dissection should be conciderded in multifocal tumor.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]