分化型甲状腺癌中央区淋巴结清扫范围和指征的发展与思考  

Development and reflection on the scope and indications of central lymph node dissection for differentiated thyroid cancer

作　　者：纪小宇 张浩[1] Ji Xiaoyu;Zhang Hao(Department of Thyroid Surgery,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院甲状腺外科,沈阳110001

出　　处：《中华外科杂志》2025年第4期312-317,共6页Chinese Journal of Surgery

基　　金：辽宁省应用基础研究计划(2022020225-JH2/1013);沈阳市科技计划项目(21-173-9-31)。

摘　　要：分化型甲状腺癌(DTC)易发生中央区淋巴结转移,目前的指南和共识均明确提出甲状腺癌中央区淋巴结清扫范围包括Ⅵ区与Ⅶ区,但对于术前临床检查和术中探查未发现淋巴结转移的DTC患者,是否行预防性中央区淋巴结清扫术(pCND)仍有争议。尽管pCND对中央区淋巴结阴性(cN0期)DTC患者的长期生存率、复发率和术后甲状腺球蛋白的影响仍不明确,但其能有效移除可能存在的转移性中央区淋巴结。这不仅有助于提升手术的彻底性,还能减少再次手术时可能出现的并发症。根据2023年的《甲状腺结节与分化型甲状腺癌诊治指南(第二版)》及国内学者的普遍看法,对于cN0期DTC患者,建议实施与病灶同侧的pCND。在进行pCND时,必须注意保持手术范围的准确性,以最大限度地减少术后发生并发症的风险。Differentiated thyroid cancer(DTC)is prone to central lymph node metastasis.Current guidelines and consensus explicitly state that the central lymph node range for thyroid cancer includes regionsⅥandⅦ.However,there is still controversy regarding the implementation of prophylactic central lymph node dissection(pCND)in DTC patients who have no lymph node metastasis detected by preoperative clinical examination and intraoperative exploration.Although the role of pCND in long-term survival,recurrence rate,and postoperative thyroglobulin levels in cN0 DTC patients remains unclear,it can effectively remove potentially metastatic lymph nodes in the central area.This not only helps to enhance the thoroughness of the surgery but also reduces the potential complications of reoperation.According to the“Diagnosis and treatment guidelines for thyroid nodules and differentiated thyroid cancer(second edition)”from 2023 and the general opinion of domestic scholars,it is recommended to perform pCND on the same side as the lesion for cN0 DTC patients.When performing pCND,it is crucial to maintain the accuracy of the surgical scope to minimize the risk of postoperative complications.

关 键 词：甲状腺肿瘤 颈淋巴结清扫术 中央区淋巴结清扫 指南 术前评估 

分 类 号：R736.1[医药卫生—肿瘤]