[改良根治性颈清扫术在甲状腺乳头状癌中的意义]

[Significance of modified radical neck dissection in papillary thyroid carcinoma].

作者信息

Hu An, Jin Xiaojie, Qian Min fei, Zhou Ming, Li Jiping, Wang Jiadong

机构信息

Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, 200001, China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2009 Sep;23(18):828-31.

PMID:20120861

Abstract

OBJECTIVE

To investigate the recurrence of the neck and survival incidence of clinically possible positive lateral cervical nodes in patients with well-differentiated papillary thyroid cancer and the essentiality of the perforation of modified radical neck dissection.

METHOD

Retrospective datum of 267 cases of papillary thyroid carcinoma were collected and analyzed. They were divided into two groups with time; selective neck dissection with VI area was performed in 151 cases of group A and selective neck dissection was performed without VI area in 116 cased of group B. They were received the same treatment in the thyroid--total thyroidectomy on initial part and subtotal thyroidectomy on the other, and total thyroidectomy on both parts if both were invited. Incidence of positive lateral cervical nodes of VI area in group A and the recurrence in the neck and survival incidence in groups B were analyzed.

RESULT

Fifty nine patients in group A were treated with the modified radical neck dissection, and 22 patients of them were found metastasis in lateral cervical nodes with VI area. The other 92 patients were treated with neck dissection of II, III, IV, VI area, and 31 patients weren't metastasis, 33 patients were metastasis in both VI area and the others (35.8%), 17 patients were metastasis only in VI area (18.4%), 11 patients weren't metastasis only in VI area (11.9%). Thus, the incident of metastasis in VI area was 47.70% in group A (72/151). 47 patients in group B had metastasis in lateral cervical nodes though without performing VI area neck dissection (40.5%), and the survival rate of 5 years was 99.3%. The recurrence rate in the neck of group two was 6.0% (7/116). The metastasis rate of neck lymph node was higher in group A (54.9%) than group B (40.5%).

CONCLUSION

Pretracheal and peripheral recurrent nerve lymph node are very susceptible to the metastasis of well-differentiated papillary thyroid cancer. The neck dissection of VI area could be performed as routine.

摘要

目的

探讨分化型甲状腺乳头状癌患者临床可疑阳性侧颈部淋巴结的复发及生存情况，以及改良根治性颈清扫术VI区穿孔的必要性。

方法

收集并分析267例甲状腺乳头状癌患者的回顾性资料。按时间分为两组；A组151例患者行VI区选择性颈清扫术，B组116例患者未行VI区选择性颈清扫术。两组患者在甲状腺治疗上，一部分行全甲状腺切除术，另一部分行甲状腺次全切除术，若两者均有需要则均行全甲状腺切除术。分析A组VI区侧颈部淋巴结阳性发生率及B组颈部复发率和生存率。

结果

A组59例患者行改良根治性颈清扫术，其中22例患者侧颈部VI区淋巴结转移。其余92例患者行II、III、IV、VI区颈清扫术，31例患者无转移，33例患者VI区及其他区域转移（35.8%），17例患者仅VI区转移（18.4%），11例患者仅VI区无转移（11.9%）。因此，A组VI区转移发生率为47.70%（72/151）。B组47例患者虽未行VI区颈清扫术，但侧颈部淋巴结转移（40.5%），5年生存率为99.3%。第二组颈部复发率为6.0%（7/116）。A组颈部淋巴结转移率（54.9%）高于B组（40.5%）。