甲状腺乳头状癌侧方转移的选择性气管旁颈部清扫术：是否有必要？
Elective paratracheal neck dissection for lateral metastases from papillary carcinoma of the thyroid: is it indicated?
作者信息
Khafif Avi, Ben-Yosef Rami, Abergel Avrum, Kesler Ada, Landsberg Roee, Fliss Dan M
机构信息
The Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
Head Neck. 2008 Mar;30(3):306-10. doi: 10.1002/hed.20696.
BACKGROUND
Therapeutic paratracheal neck dissection for patients with papillary carcinoma of the thyroid is standard treatment. Its use as an elective procedure is controversial.
METHODS
Thirty-seven patients with papillary carcinoma of the thyroid and evidence of positive adenopathy at levels II-V underwent selective neck dissection and elective/therapeutic paratracheal neck dissection. Results of preoperative ultrasonography of the neck were compared with the dissection specimens.
RESULTS
Morbidity of the surgical procedure was minimal (1 permanent hypocalcemia). All specimens showed metastases from papillary thyroid carcinoma: 100% (37/37) in the jugular chain of lymphatics and 83.7% (31/37) in the paratracheal region. The rate of occult (negative physical examination and ultrasonography) metastases in the paratracheal region in the presence of metastases in the ipsilateral jugular chain was 83.3% (20/24).
CONCLUSION
The high rate of occult metastases in the paratracheal region and the low rate of surgical morbidity speak in favor of elective paratracheal neck dissection in patients with metastatic papillary carcinoma of the thyroid.
背景
对于甲状腺乳头状癌患者，治疗性气管旁颈部清扫术是标准治疗方法。将其作为选择性手术存在争议。
方法
37例甲状腺乳头状癌且Ⅱ - Ⅴ区有阳性淋巴结病证据的患者接受了选择性颈部清扫术和选择性/治疗性气管旁颈部清扫术。将术前颈部超声检查结果与清扫标本进行比较。
结果
手术并发症发生率极低（1例永久性低钙血症）。所有标本均显示有甲状腺乳头状癌转移：颈淋巴结链转移率为100%（37/37），气管旁区域转移率为83.7%（31/37）。在同侧颈淋巴结链存在转移的情况下，气管旁区域隐匿性（体格检查和超声检查阴性）转移率为83.3%（20/24）。
结论
气管旁区域隐匿性转移率高且手术并发症发生率低，支持对转移性甲状腺乳头状癌患者进行选择性气管旁颈部清扫术。
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