Monacelli M, D'Ajello M, Calzolari F, Lucchini R, Misso C, Di Carlo L, Semeraro A, Daddi N, Sciamannini M, Lomonaco A, Avenia N
Azienda Ospedaliera "S. Maria" di Terni, Area Funzionale Omogenea Interaziendale di Endocrinochirurgia del Collo e Tessuti Molli, Italy.
G Chir. 2006 Aug-Sep;27(8-9):311-4.
At present we are still debating on which is the most adequate therapeutic strategy concerning the size of the thyroidectomy and the extension of the lymphectomy in differentiated thyroid tumors.
From January 2000 to December 2005, 334 operations for thyroid neoplasms have been performed; 304 (91%) for differentiated tumors. In 124 cases (37%) the latero-cervical and/or the central compartment lymphectomy have been associated with thyroidectomy: 79 monolateral and central compartment lymphectomies (ML and CCL) (64%), 11 bilateral and central compartment lymphectomies (BL and CCL) (8%), and 34 central compartment lymphectomies (CCL) (28%) have been performed.
Out of the 124 lymphectomies, in 44 cases (35.5%) we found the presence of metastasis in the lymph nodes of latero-cervical and central compartments, in 10 cases (8%) absence of metastasis in the lymph nodes of the latero-cervical and central compartments, in 25 cases (20%) presence of metastasis in the latero-cervical lymph nodes and absence of metastasis in the lymph nodes of the central compartment. In 11 cases of bilateral and central compartment lymphectomies, 5 of them (4%) had positive lymph nodes of the latero-cervical and central compartments, while the other, only 6 (5%), had positive latero-cervical lymph nodes on the same side as the neoplasia. In 34 central compartment lymphectomies there was absence of metastasis. Mortality rate was zero. There was one case (0.8%) of recurrent laryngeal nerve temporary bilateral palsy (RTBP); 4 cases (3.2%) of recurrent temporary monolateral palsy (RTMP); 2 cases (1.6%) of definitive monolateral palsy (DMP); 29 cases (23.5%) of temporary hypoparathyroidism (TH); 7 cases (5.5%) of definitive hypoparathyroidism (DH).
Latero-cervical lymphectomy should be performed by necessity when clinical tests or pre-diagnostic exams show suspect lymph nodes, whereas central compartment lymphectomy should be performed in any case of thyroid neoplasia.
目前，我们仍在就分化型甲状腺肿瘤甲状腺切除术的范围及淋巴结清扫的范围，哪种治疗策略最为合适展开讨论。
2000年1月至2005年12月，共进行了334例甲状腺肿瘤手术；其中304例（91%）为分化型肿瘤。124例（37%）患者的甲状腺切除术同时进行了颈侧区和/或中央区淋巴结清扫：79例进行了单侧及中央区淋巴结清扫（ML和CCL）（64%），11例进行了双侧及中央区淋巴结清扫（BL和CCL）（8%），34例进行了中央区淋巴结清扫（CCL）（28%）。
在124例淋巴结清扫术中，44例（35.5%）在颈侧区及中央区淋巴结发现转移，10例（8%）颈侧区及中央区淋巴结无转移，25例（20%）颈侧区淋巴结有转移而中央区淋巴结无转移。在11例双侧及中央区淋巴结清扫术中，5例（4%）颈侧区及中央区淋巴结阳性，而另外6例（5%）仅肿瘤同侧颈侧区淋巴结阳性。34例中央区淋巴结清扫术中无转移。死亡率为零。有1例（0.8%）出现双侧喉返神经暂时性麻痹（RTBP）；4例（3.2%）出现单侧喉返神经暂时性麻痹（RTMP）；2例（1.6%）出现单侧喉返神经永久性麻痹（DMP）；29例（23.5%）出现暂时性甲状旁腺功能减退（TH）；7例（5.5%）出现永久性甲状旁腺功能减退（DH）。
当临床检查或术前诊断检查显示淋巴结可疑时，有必要进行颈侧区淋巴结清扫，而对于任何甲状腺肿瘤病例均应进行中央区淋巴结清扫。
