cN0期甲状腺乳头状癌中央组淋巴结预防性清扫的研究进展  

Research progress of prophylactic central lymph node dissection in cN0 papillary thyroid cancer

作　　者：师帅 付言涛[1] SHI Shuai;FU Yantao(Department of Thyroid Surgery,China-Japan Union Hospital,Jilin University,Jilin Provincial Key Laboratory of Surgical Translational Medicine,Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院甲状腺外科,吉林省外科转化医学重点实验室,吉林省甲状腺疾病防治工程实验室,吉林长春130033

出　　处：《中国普通外科杂志》2020年第11期1376-1384,共9页China Journal of General Surgery

摘　　要：近年来甲状腺癌已经成为全世界发病率最高的内分泌肿瘤,其中甲状腺乳头状癌(PTC)是最常见的类型,约占总体甲状腺癌的90%。尽管PTC进展缓慢,预后良好,但是PTC早期易发生颈部淋巴结转移,尤其是中央组淋巴结转移(CLNM),其转移率为21.2%~64.1%。对于术前已明确有CLNM的患者,行中央区淋巴结清扫术(CLND)已经被国内外学者所认可,但是目前对于cN0期PTC是否行预防性CLND以及手术清扫的范围尚存在争论,我国关于分化型甲状腺癌指南建议在有技术保障的前提下,对cN0期PTC患者行病灶同侧CLND,而美国甲状腺协会最新指南指出预防性CLND不能改善患者长期生存率,还有可能增加并发症的发生率。由此可见,cN0期PTC是否行预防性CLND尚存在争议。笔者从CLNM相关因素、转移模式、影像学评估以及清扫技术革新等方面进行综述。In recent years,thyroid cancer has become the most prevalent endocrine cancer in the world,in which papillary thyroid cancer(PTC)is the most common type,accounting for about 90%of all thyroid cancers.Although PTC has a favorable prognosis,some PTC patients will develop early lymph node metastasis,especially the central lymph node metastasis(CLNM),with metastasis rate of 21.2%to 64.1%.For patients with confirmed CLNM,performing central lymph node dissection(CLND)has been becoming widely accepted by domestic and international scholars.However,as for CN0 tumor,there is still controversial about whether or not prophylactic CLND should be performed as well as the surgical scope.China’s guideline for differentiated thyroid cancer suggests that ipsilateral CLND should be performed for patients with cN0 PTC on the premise of the effective technical guarantee.However,the latest guideline of the American Thyroid Association points out that prophylactic CLND is ineffective in improving long-term survival,but may increase the incidence of complications.So,whether or not performing a prophylactic CLND for cN0 PTC patients failed to reach a agreement.Here,the authors address the issues concerning the related factors,metastasis patterns,imaging evaluation and technical innovation of CLNM.

关 键 词：甲状腺肿瘤 甲状腺癌 乳头状 淋巴转移 颈淋巴结清扫术 综述 

分 类 号：R736.1[医药卫生—肿瘤]