机构地区:[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院头颈外科,北京100021
出 处:《中华医学杂志》2020年第24期1866-1871,共6页National Medical Journal of China
基 金:中国医学科学院医学与健康科技创新工程(2017-I2M-1-005)。
摘 要:目的探讨甲状腺乳头状癌纵隔淋巴结转移规律及胸骨劈开入路治疗性纵隔淋巴结清扫在甲状腺乳头状癌纵隔淋巴结转移治疗中的应用。方法收集2006年1月至2017年1月中国医学科学院肿瘤医院胸外科与头颈外科联合,通过胸骨劈开入路治疗甲状腺乳头状癌纵隔淋巴结转移的全部病例,对纵隔淋巴结转移的分布、转移率、转移程度、手术方法、手术并发症及患者术后生存情况进行回顾性分析。结果共入组31例患者,男16例,女15例,年龄46(19~65)岁,经部分胸骨劈开入路治疗28例,全胸骨劈开入路治疗3例。除3P、4L、7区未见淋巴结转移外,甲状腺乳头状癌纵隔淋巴结最远转移至6组,各组淋巴结转移率由高到低依次为2R(61%)、1R(39%)、3A(39%)、1L(16%)、2L(10%)、4R(10%)、5区(3%)、6区(3%)。同时,2R区阳性淋巴结比例也最高,达35%(77/219)。甲状腺乳头癌纵隔转移淋巴结结外侵犯常见(23%),易融合成团(23%)并侵犯周围血管神经(26%)。术中或术后因渗血或出血多而需要输血比例高达29%。全部患者术后1、3、5及10年生存率分别为94%、94%、87%、81%。结论除3P、4L和7区未见转移外,甲状腺乳头状癌可转移至纵隔其余各站淋巴结,胸骨劈开纵隔淋巴结清扫是甲状腺乳头状癌纵隔淋巴结转移的有效治疗手段。Objective To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma.Methods All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study.The distribution,metastasis rate,metastasis degree,surgical method,surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed.Results A total of 31 patients(16 males and 15 females)with papillary thyroid cancer with mediastinal lymph node metastasis,with a median age of 46(19-65)years,were enrolled in the group.Partial upper sternotomy was used in 28 cases,and total sternotomy was used in 3 cases.The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6,and the lymph node metastasis rate of each group from high to low was:2R(61%),1R(39%),3A(39%),1L(16%),2L(10%),4R(10%),5(3%)and 6(3%).No metastasis was observed in station 3P,4L and 7.In addition,the degree of lymph node metastasis at station 2R was the highest,reaching 35%(77/219).Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common(23%),easily fuses into masses(23%)and invades peripheral vascular nerves(26%).Up to 29%of blood transfusions are required during or after surgery due to oozing or bleeding(9/31).The 1-,3-,5-and 10-year survival rates of patients undergoing surgical treatment were 94%,94%,87%and 81%,respectively.Conclusion Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P,4L and 7.Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatm
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