甲状腺乳头状癌术中右侧喉返神经深层淋巴结清扫的经验和体会  

The significance of deep laryngeal nerve lymph node dissection in the operation of papillary thyroid carcinoma

作　　者：韩彬[1] 王东来[1] 李朋[1] 邹丽 韦伟[1] HAN Bin;WANG Donglai;LI Peng;ZOU Li;WEI Wei(Department of Breast and Thyroid,PEKING University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院乳腺甲状腺外科,广东深圳518036

出　　处：《岭南现代临床外科》2018年第4期421-424,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省深圳市三名工程资助项目(SZSM201612010)

摘　　要：目的探讨甲状腺乳头状癌手术中,进行右侧喉返神经深层淋巴结清扫的必要性和意义。方法 2017年5月至2018年3月收治的102例甲状腺乳头状癌(右侧或双侧)行根治术的患者,均行了包括右侧中央区喉返神经浅层与深层的淋巴结清扫。术后将浅层及深层的淋巴结转移情况进行对比分析。再将患者年龄、性别、肿瘤大小、是否包膜受侵、是否合并桥本甲状腺炎、喉前淋巴结转移情况等临床资料,与淋巴结转移情况进行对比分析。结果中央区右侧喉返神经深层淋巴结转移率为23.5%,浅层转移为61.8%,仅深层淋巴结转移而无浅层转移的比例为1.3%,右侧中央区总体淋巴结转移率为65.7%。喉返神经深层淋巴结转移率在患者年龄、性别、包膜受侵、桥本甲状腺炎等情况无明显统计学差异,但与肿块大小、病灶数目、喉前淋巴结是否转移,以及右侧喉返神经浅层淋巴结是否转移密切相关,P<0.05。结论甲状腺乳头状癌在进行右侧中央区淋巴结清扫时,由于存在喉返神经深层淋巴结转移,为保证根治手术的彻底性,不仅要行喉返神经浅层的清扫,也要进行深层淋巴结的清扫,特别是当肿瘤较大、多病灶、有喉前和浅层淋巴结转移时。Objective To investigate the necessity and significance of deep laryngeal lymph node dissection in the operation of papillary thyroid carcinoma.Methods From May 2017 to March 2018,102 cases of thyroid papillary carcinoma(right or bilateral)were treated with radical resection,including lymph node dissection of the superficial and deep layer of the recurrent laryngeal nerve in the right central region.The superficial and deep lymph node metastases were compared after operation.The clinical data of the patients--age,sex,tumor size,the invasion of the envelope,the combination of Hashimoto--s thyroiditis and the lymph node metastasis of the larynx were analyzed and compared with the lymph node metastasis.Results(1)The rate of the deep lymph node metastasis of the right recurrent laryngeal nerve in the central area was 23.5%,the superficial metastasis was 61.8%,the proportion of the deep lymph node metastasis only and the non superficial metastasis was 1.3%,and the total lymph node metastasis rate in the right central area was 65.7%.(2)There was no significant difference in the rate of the deep lymph node metastasis of the recurrent laryngeal nerve in the patient--s age,sex,the invasion of the envelope and Hashimoto--s thyroiditis,but it was closely related to the size of the lump,the number of lesions,the metastasis of the anterior larynx lymph nodes,and the metastasis of the superficial lymph node of the right laryngeal nerve,P<0.05.Conclusion On the right or bilateral papillary thyroid carcinoma in the right central region of the lymph node dissection,due to the existence of a certain rate of the deep lymph node metastasis of the recurrent laryngeal nerve,in order to ensure the radical operation of the radical operation,it is necessary not only to clean the superficial laryngeal nerve,but also to clear the deep lymph nodes,especially when the tumor is larger,multifocal and there is a anterior larynx and superficial lymph node metastases.

关 键 词：甲状腺乳头状癌 中央区淋巴结清扫术 右侧喉返神经深层淋巴结清扫 

分 类 号：R653[医药卫生—外科学]