| 戴信深,郭 良,赵佳正.68例甲状腺乳头状癌颈侧区淋巴结清扫分析[J].肿瘤学杂志,2020,26(2):2-133. |
| 68例甲状腺乳头状癌颈侧区淋巴结清扫分析 |
| Lymph Node Metastasis in Cervical Region of 68 Cases with Papillary Thyroid Carcinoma |
| 投稿时间：2019-11-14 |
| DOI：10.11735/j.issn.1671-170X.2020.02.B011 |
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| 中文关键词: 癌，甲状腺乳头状 危险因素 淋巴结转移 颈淋巴结清扫 |
| 英文关键词:papillary thyroid carcinoma risk factors lymphatic metastasis neck dissection |
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| 中文摘要: |
| 摘 要：［目的］ 探讨甲状腺乳头状癌(PTC)颈侧区淋巴结转移的规律，为临床颈侧区淋巴结清扫提供依据。［方法］ 应用丝线定位法，精准划分颈淋巴结各分区，对收治的68例cN1b PTC患者，均行包含Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴa、Ⅴb区和LNSS的颈侧区淋巴结清扫，共行侧颈部淋巴结清扫82侧。分析颈侧区淋巴结转移情况，探讨Ⅱb区、Ⅴa区、Ⅴb区、LNSS以及淋巴结跳跃性转移的规律。［结果］ cN1b患者总颈淋巴结转移率92.6%（63/68），其中颈侧区转移率86.8%（59/68），中央区转移率79.4%（54/68）。侧颈清扫82侧，中央区清扫83侧，中央区淋巴结转移率为78.3%，Ⅲ区为62.2%，Ⅳ区为57.3%，Ⅱ区为47.6%（Ⅱa区43.8%，Ⅱb区7.3% ），Ⅴ区为15.9%（Ⅴa区11.0%，Ⅴb区6.1%），LNSS转移率为9.8% 。在Ⅱb区转移的患者中伴有Ⅱa区淋巴结转移或颈侧区多区域（2个以上区域）淋巴结同时转移情况多见；在Ⅴa区和Ⅴb区转移的患者中，伴有肿瘤被膜侵犯和颈侧区2个以上区域淋巴结同时转移情况较多；在LNSS转移的患者中，伴有 Ⅳ区淋巴结转移和原发灶肿瘤位于甲状腺下极较多；在颈侧区淋巴结跳跃性转移患者中，原发灶肿瘤多位于甲状腺上极。［结论］ cN1b PTC应常规清扫Ⅱa、Ⅲ、Ⅳ区淋巴结。保证副神经功能前提下，Ⅱa区或颈侧区≥2区域有淋巴结转移，需考虑清扫Ⅱb区淋巴结。有Ⅱ~Ⅳ区中多区同时转移或原发灶肿瘤明显被膜侵犯，需考虑清扫Ⅴ区淋巴结。当原发灶肿瘤位于甲状腺下极或Ⅳ区淋巴结有转移，清扫LNSS应更积极。原发灶肿瘤位于甲状腺上极患者，跳跃性淋巴结转移更常见。 |
| 英文摘要: |
| Abstract：［Objective］ To analyzethe lymph node metastasis in cervical region of papillary thyroid carcinoma(PTC). ［Methods］ Sixty-eight patients with cN1b PTC undergoing surgical treatment were enrolled in the study. With the surgical suture positioning method，the dissections of lateral cervical lymph nodes were performed，including Ⅱa，Ⅱb，Ⅲ，Ⅳ，Ⅴa，Ⅴb and lymph node between sternocleidomastoid and sternohyoid muscle(LNSS). Totally the 82 sides lateral cervical lymph nodes were dissected； and the mode of lymph node metastasis in the lateral cervical was analyzed.［Results］ The total cervical lymph node metastasis rate in 68 patients was 92.6%(63/68)，themetastasis rate of lateralregion was 86.8%(59/68)，and the metastasis rate of central region was 79.4%(54/68). The lateral neck lymph node was dissected on the 82 sides，and the central lymph node was removed on the 83 side. The central lymph node metastasis rate was 78.3%，that in level Ⅲ was 62.2%，in level Ⅳ was 57.3%，in level Ⅱwas 47.6%(43.8% in level Ⅱa，7.3% in level Ⅱb)，and 15.9% in level Ⅴ(level Ⅴa was 11.0 %，level Ⅴb was 6.1%)，and LNSS metastasis rate was 9.8%. In patients with metastasis in the level Ⅱb，lymph node metastasis in the level Ⅱa or multiple lateral cervical region(more than 2 regions) were more common. In patients with metastasis in the level Ⅴa and Ⅴb，the tumor extra-capsular invasion and multiple lateral cervical region lymph node metastasis(more than 2 regions)were more common. In patients with LNSS metastases，level Ⅳ lymph node metastasis were common，and tumors were likely to locate in the lower part of the thyroid gland. In patients with skip metastasis，the tumor was likely to locate in the upper part of the thyroid.［Conclusion］ The patients with cN1b papillary thyroid carcinoma should be routinely cleaned for lymph nodes in level Ⅱa，Ⅲ and Ⅳ. Under the premise of ensuring the function of the accessory nerve，patients with lymph node metastasis in the level Ⅱa or lymph node metastasis ≥2 regions of the lateral cervical region need to clean the lymph nodes in the level Ⅱb. Patients with multiple metastases in the level Ⅱ~Ⅳ or patients with tumor extra-capsular invasion need to clean the level Ⅴ. LNSS should be removed more actively when the tumor is located in the lower part of the thyroid or with metastatic lymph nodes in the level Ⅳ. Skip metastasis is more common when the tumor is located in the upper thyroid gland. |
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