甲状腺乳头状癌二次颈侧淋巴结清扫的临床分析  

Clinical analysis of secondary cervical lymph node dissection in papillary thyroid carcinoma

作　　者：何雨沁 刘绍严[1] 徐震纲[1] 唐平章[1] 黄辉[1] 王健[1] 朱一鸣[1] 鄢丹桂[1] 张宗敏[1] 倪松[1] 

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院头颈外科,100021

出　　处：《中华肿瘤杂志》2017年第8期624-627,共4页Chinese Journal of Oncology

摘　　要：目的分析甲状腺乳头状癌（PTC）二次颈侧淋巴结清扫的临床意义。方法收集2000年1月1日至2016年12月31日间行二次清扫的PTC患者，以两次手术间隔时间≤6个月和〉6个月进行分组，分析二次清扫区域淋巴结转移情况，包括淋巴结转移区域、淋巴结转移数目、淋巴结清扫数目，计算淋巴结转移率。结果336例PTC患者共行360侧颈侧淋巴结清扫，其中单侧颈侧淋巴结转移率为92.9%（312/336），多区域（≥2个区域）淋巴结转移率为47.5%（171/360）。Ⅱ、Ⅲ、Ⅳ和Ⅴ区淋巴结转移率分别为55.6%（200/360）、44.2%（159/360）、59.7%（215/360）和10.3%（37/360）。转移淋巴结主要位于Ⅱ区（33.6%）和Ⅳ区（35.8%）。手术间隔时间≤6个月组清扫淋巴结26.56枚/例，转移淋巴结4.37枚/例。手术间隔时间〉6个月组清扫淋巴结16.80枚/例，转移淋巴结3.20枚/例。两组淋巴结清扫数目和淋巴结转移数目差异均有统计学意义（P＝0.001，P〈0.001）。结论PTC患者二次颈侧淋巴结清扫以Ⅱ、Ⅳ区淋巴结转移多见，其中多区域淋巴结转移并不少见，Ⅱ、Ⅳ区域首次清扫时尤需重视。大部分行二次清扫的PTC患者为首次手术后淋巴结残留，为减少淋巴结残留，对PTC患者实施规范的颈淋巴结清扫术尤为重要。ObjectiveTo investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma （PTC）.MethodsPTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis.ResultsA total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%（312/336）. The ratio of recurrence in multiple levels （more than two regions） were 47.5% （171/360）. The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%（200/360）, 44.2%（159/360）, 59.7%（215/360） and 10.3%（37/360）, respectively. Lymph node metastases were inclined to level Ⅱ （33.6%） and Ⅳ （35.8%）. The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval 〉6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different （P=0.001, P〈0.001）.ConclusionsLymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.

关 键 词：甲状腺肿瘤 颈部淋巴结清扫术 肿瘤复发 

分 类 号：R736.1[医药卫生—肿瘤]