Ⅵc亚分区在预测cN0单侧甲状腺乳头状癌对侧中央区淋巴结转移中的价值探讨  

Value of pretracheal lymph node subdivision in predicting contralateral central lymph node metastasis for cN0 unilateral papillary thyroid carcinoma

作　　者：张佩 卢苇 宋琳琳 陈强[2] 苏安平[2] 刘枫[2] 朱精强[2] ZHANG Pei;LU Wei;SONG Linlin;CHEN Qiang;SU Anping;LIU Feng;ZHU Jingqiang(West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Thyroid&Parathyroid Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院,成都610041 [2]四川大学华西医院甲状(旁)腺外科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第10期1339-1343,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨气管前(Ⅵc)亚分区在预测颈部临床淋巴结阴性(clinical lymph node negative,cN0)单侧甲状腺乳头状癌对侧中央区淋巴结转移的价值。方法 回顾性收集四川大学华西医院甲状腺(旁)外科2017年7月1日至2021年6月30日期间初次行甲状腺全切除+双侧中央区淋巴结清扫并按照Ⅵc亚分区标记送术后石蜡病理检测的cN0单侧甲状腺乳头状癌患者的临床病理资料。Ⅵc亚分区以气管前壁中线为界将Ⅵc区淋巴结分为Ⅵc1(右侧气管前)及Ⅵc2(左侧气管前),若淋巴结跨越气管中线则纳入癌灶侧。结果 共纳入175例患者,发生Ⅵd(喉前)区、Ⅵc区、癌灶同侧Ⅵc区、癌灶对侧Ⅵc区、同侧中央区及对侧中央区淋巴结转移分别为54例(30.9%)、118例(67.4%)、85例(48.6%)、72例(41.1%)、108例(61.7%)及43例(24.6%)。单因素分析影响对侧中央区淋巴结转移因素的结果显示,Ⅵd区、Ⅵc区、癌灶对侧Ⅵc区及同侧中央区淋巴结转移均与对侧中央区淋巴结转移有关(P<0.05);对此进一步进行二元logistic回归多因素分析结果发现,有Ⅵd区和癌灶对侧Ⅵc区淋巴结转移增加对侧中央区淋巴结转移发生的概率(OR=4.444、P<0.001;OR=6.655、P=0.001)。结论 本研究结果提示,Ⅵc亚分区合理有效,对cN0单侧甲状腺乳头状癌患者对侧中央区淋巴结转移有一定的预测价值,对这类患者术中冰冻发现癌灶对侧Ⅵc区淋巴结转移时建议行双侧中央区淋巴结清扫。Objective To investigate the predictive value of pretracheal lymph node(Ⅵc) subdivision for contralateral central lymph node(CLN) metastasis in clinical lymph node negative(cN0) unilateral papillary thyroid carcinoma(PTC). Methods The data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea(Ⅵc1) and left anterior trachea(Ⅵc2);If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. Results A total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal(Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54cases(30.9%), 118 cases(67.4%), 85 cases(48.6%), 72 cases(41.1%), 108 cases(61.7%), and 43 cases(24.6%), respectively.The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions;The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis(OR=4.444, P<0.001;OR=6.655, P=0.001). Conclusions From the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.

关 键 词：甲状腺乳头状癌 临床淋巴结阴性 气管前淋巴结 喉前淋巴结 中央区淋巴结清扫 

分 类 号：R736.1[医药卫生—肿瘤]