细化分析甲状腺乳头状癌Ⅱ区淋巴结转移特点  

Level lI lymph node metastasis of papillary thyroid carcinoma

作　　者：蔡永聪[1] 陈锦[1] 陈建超[1] 王朝晖[1] 

机构地区：[1]四川省肿瘤医院头颈外科,成都610041

出　　处：《中华内分泌外科杂志》2016年第4期287-290,共4页Chinese Journal of Endocrine Surgery

基　　金：四川省卫生和计划生育委员会科研项目（150239）

摘　　要：目的探讨PTCII区淋巴结转移与甲状腺疾病背景、肿瘤大小、位置及区域淋巴结相关转移等的关系。方法采用Access数据库软件行TC数据库建设，回顾性细化分析2013年8月至2014年3月四川省肿瘤医院头颈外科一病区收治的62例行颈部淋巴结清扫的PTC患者的临床资料，包括性别、年龄、甲状腺疾病背景、病灶数量、大小、位置、淋巴结转移数目等。结果Ⅱ区淋巴结转移30例（其中Ⅱa区27例．Ⅱb区6例）。没有任何甲状腺疾病背景的患者Ⅱ区转移（13／23），合并桥本氏甲状腺炎（9／17），合并结节性甲状腺肿（3／18），甲状腺功能亢进碘131治疗后（2，2）；肿瘤直径〈10Inm（2／15），肿瘤大小10～40mm（17／32）．肿瘤直径〉40mm（4／7）。肿瘤位于上极（11／17），中份（12／23），下极（3／12）。结论Ⅱ区淋巴结转移在PTC中并不少见，目前的报道大多认同当Ⅲ区、Ⅳ区多发淋巴结转移或包膜外侵时，Ⅱ区阳性率较高，应当清扫。除传统危险分层外，Ⅱ区淋巴结转移特点与原发灶肿瘤位置及大小、甲状腺疾病背景等均有相关性，为了减少患者手术创伤、手术并发症，对每位患者予以个体化手术治疗方案，特别是肿瘤位于中上份，Ⅱ区淋巴结应予以重视。Objective To investigate the correlation between level II cervical lymph node metastasis （CLNM） and thyroid disease background, tumor size, location, and local lymph node metastasis in patients with papillary thyroid carcinoma （PTC）. Methods A thyroid cancer database was established using Access database software. 62 patients with PTC undergoing neck dissection in the 1st Department of Head and Neck surgery of Sichuan Cancer Hospital from Aug. 2013 to Mar. 2014 were retrospectively reviewed in terms of their sex, age, thyroid disease background, number of nodules, tumor size, location, and CLNM. Results 30 out of 62 patients had level II cervical lymph node metastasis （IIa： 27 cases, IIb： 6 cases）. 13 out of 23 patients without history of other thyroid disease had level II CLNM, 9 out of 17 patients with Hashimoto＇s thyroiditis had level II CLNM, 3 out of 18 patients concomitant with nodular goiter had level II CLNM and 2 patients concomitant with hyperthy- roidism and having received radioactive iodine 131 treatments had level II CLNM. Among patients with level II CLNM, 2 patients had tumors 〈10 mm, 17 patients had tumors between 10 mm and 40 mm, and 4 patients had tumors 〉40 mm. Most of the tumors （11/17） with level II CLNM were located in the upper polar of the thyroid, while the rest were located in the middle （12/23） and lower （3/12） region of thyroid. Conclusions Level II CLNM is a common feature of thyroid carcinoma. It has been well accepted that level II cervical lymph node should be dissected when extracapsular invasion or CLNM to level III or IV occurs. In addition to traditional risk stratification, level II CLNM is correlated with tumor size, location, and thyroid disease background. Therefore, close attention should be paid to level II cervical lymph node when tumors are located in the upper polar of thy- roid and individualized treatment should be chosen for each patient.

关 键 词：甲状腺乳头状癌 颈清扫术 颈淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]