甲状腺乳头状癌喉返神经入喉处淋巴结清扫的临床意义  

Recurrent laryngeal nerve inlet zone lymph node metastasis in papillary thyroid cancer

作　　者：郑桂彬[1] 孙海清 吴国长[1] 马驰 张国军 郭雅文 陈焕杰 林湘峰 韦树建 赵辉[1] 宋西成[3] 郑海涛[1] Zheng Guibin;Sun Haiqing;Wu Guochang;Ma Chi;Zhang Guojun;Guo Yawen;Chen Huanjie;Lin Xiangfeng;Wei Shujian;Zhao Hui;Song Xicheng;Zheng Haitao(Thyroid Surgery Department,Affiliated Yantai Yuhuangding Hospital,Qingdao University,Shandong Province 264000,China;Changle People's Hospital,Shandong Province 261000,China;Otorhinolaryngology Head and Neck Surgery Department,Affiliated Yantai Yuhuangding Hospital,Qingdao University^Shandong Province 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院甲状腺外科,山东省264000 [2]潍坊市昌乐县人民医院,山东省261000 [3]青岛大学附属烟台毓璜顶医院耳鼻咽喉头颈外科,山东省264000

出　　处：《中华普通外科杂志》2020年第9期709-712,共4页Chinese Journal of General Surgery

摘　　要：目的探究甲状腺乳头状癌患者喉返神经入喉处区域(recurrent laryngeal nerve inlet zone,RLNIZ)淋巴结转移情况及临床意义.方法回顾性分析2017年7月至2018年6月烟台毓璜顶医院甲状腺外科738例甲状腺乳头状癌患者病例资料,将108例单独送检RLNIZ淋巴结的病例纳入研究,统计分析RLNIZ淋巴结转移情况与患者临床病理特点的关系.结果RLNIZ淋巴结整体检出率为12.3%(91/738),平均淋巴结检出数目为1.5±0.7,淋巴结转移率为30.8%(28/91).RLNIZ淋巴结转移与肿瘤直径(P=0.028)、被膜侵犯(P=0.019)、中央区淋巴结转移数目(P<0.001)及侧颈部淋巴结转移(P<0.001)相关,其中中央区淋巴结转移数目为RLNIZ淋巴结转移独立危险因素.上位甲状旁腺损伤及吞咽功能障碍发生率为0.9%(1/108).结论RLNIZ淋巴结转移常见于肿瘤负荷高的患者.对于术前影像学发现肿瘤>1 cm、可疑被膜侵犯、侧颈部淋巴结转移患者术中需常规行RLNIZ淋巴结清扫.Objective To explore the clinical significance of recurrent laryngeal nerve inlet zone(RLNIZ)lymph node metastasis in papillary thyroid cancer(PT C).Methods The clinical data of the clinicopathologic characteristics of 738 cases with papillary thyroid cancer at our centers from Jul 2017 to Jun 2018 was retrospectively reviewed.108 cases with RLNIZ lymph node dissection for pathological examination were included.The relationship between metastasis of RLNIZ lymph node and clinicopathologic characteristics was analyzed.Results RLNIZ lymph node was detected in 12.3%(91/738)cases,the mean lymph node number in RLNIZ was 1.5±0.7,and 30.8%(28/91)cases suffered RLNIZ lymph node metastasis.RLNIZ lymph node metastasis(LNM)is associated with tumor size(P=0.028),capsular invasion(P=0.019),No.of central compartment LNM(P<0.001)and lateral neck LNM(P<0.001).No.of central compartment LNM was found to be the independent risk factor of RLNIZ lymph node metastasis.The incidence of dysphagia and inferior parathyroid damage was 0.9%(1/108)respectively.Conclusions RLNIZ lymph node metastasis is common among PTC patients,therefore,RLNIZ lymph node should be routinely removed especially in patients with tumor size over 1 cm.suspected capsular invasion and lateral neck lymph node metastasis confirmed by preoperative imaging examination.

关 键 词：甲状腺肿瘤 癌 乳头状 喉返神经入喉区域淋巴结 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]