cN0期甲状腺乳头状微小癌颈淋巴结清扫范围的临床评价  

Clinical assessment of neck dissection for cN0 papillary thyroid microcarcinoma

作　　者：龚文博[1] 张松涛[1] 翟翼飞[1] 黑虎[1] 秦建武[1] 

机构地区：[1]河南省肿瘤医院甲状腺头颈外科,450008

出　　处：《中华内分泌外科杂志》2015年第5期405-408,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的：探索cN0期甲状腺乳头状微小癌（ papillary thyroid microcarcinoma ，PTMC）淋巴结转移规律，并评价其颈部淋巴结清扫范围。方法对233例cN0期PTMC的临床资料行回顾性分析，用χ2检验对性别、年龄、肿瘤直径与淋巴结转移之间的关系作单因素分析。结果233例cN0期PTMC患者颈部淋巴结转移率34.8％（中央区30.0％，侧颈部9.9％）。肿瘤直径≤5 mm者与＞5 mm者中央区淋巴结转移率分别为21.6％和36.6％（χ2＝6.199，P＜0.05），侧颈部淋巴结转移率分别为4.9％和13.7％（χ2＝5.035，P＜0.05）；男性与女性中央区淋巴结转移率分别为42.1％、26.1％（χ2＝5.224，P＜0.05），侧颈部淋巴结转移率分别为21.1％、6.3％（χ2＝10.604，P＜0.01）。年龄≤45岁和＞45岁者的中央区淋巴结转移率分别为37.9％、21.1％（χ2＝7.792，P＜0.01）。中央区淋巴结转移时侧颈部淋巴结转移率为17.1％，中央区淋巴结未转移而发生侧颈淋巴结转移率为6.7％（χ2＝5.947，P＜0.05）。结论 cN0期PTMC患者均应规范性清扫中央区淋巴组织，对于肿瘤直径＞5 mm的男性PTMC患者应积极探查侧颈部淋巴组织，以发现亚临床转移癌灶，指导进一步手术方案。Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma（ cN0-PTMC） and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients（34.8%）had cervical lymph node metastasis （30.0%in central region and 9.9%in lateral region）. For patients with tumor diameter （ D）≤5 mm and D〉5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%（χ2 =6.199,P〈0.05） and it was 4.9% and 13.7% respectively in lateral region （χ2 =5.035,P〈0.05）.For male and female patients, lymph node metastasis rate in central region was 42.1% and 26.1%respectively（χ2 =5.224,P〈0.05）, and it was 21.1% and 6.3% respectively in lateral region （χ2 =10.604,P〈0.01）.Lymph node metastasis rate in patients≤45 years old and 〉45 years old was 37.9% and 21.1% respectively （χ2 =7.792, P 〈0.01 ） .The lateral region lymph node metastasis rate was 17.1% and 6.7%when the central region lymph node was infringed or not （χ2 =5.947, P〈0.05）.Conclusions All cN0-PTMC patients should have a normative central neck dissection .Male patients with PTMC and tumor diameter 〉5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.

关 键 词：甲状腺乳头状癌 微小癌 淋巴结转移 颈淋巴结清扫 

分 类 号：R736.1[医药卫生—肿瘤]