侧颈部疾病转移性甲状腺乳头状癌：按水平分层的扩散模式。
Metastatic papillary thyroid cancer with lateral neck disease: pattern of spread by level.
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
出版信息
Head Neck. 2013 Oct;35(10):1439-42. doi: 10.1002/hed.23149. Epub 2012 Sep 10.
BACKGROUND
Currently, there is no clear consensus on the extent of this lateral neck dissection required in papillary thyroid cancer (PTC) with lateral neck metastasis. The purpose of this study was to review our experience with metastatic PTC, and identify the pattern of lymphatic spread to the lateral neck.
METHODS
A retrospective medical chart review of PTC patients treated with lateral neck dissection (levels II-Vb) at our institution between January 2004 and 2011. A total of 185 patients underwent 248 selective lateral neck dissections.
RESULTS
Levels II, III, IV, and Vb were respectively involved in 49.3%, 76.6%, 61.6%, and 29.2% of cases.
CONCLUSION
We advocate for a routine excision of levels II, III, IV, and Vb in PTC with metastasize to any lateral neck level. Although we have routinely dissected level IIb, it may be appropriate to omit its dissection, as well as level Va, when there are no clinical, radiologic, or intraoperative evidence of disease involving these sublevels.
背景
目前，对于伴有侧颈部转移的甲状腺乳头状癌（PTC）需要进行多大范围的侧颈部清扫术，尚未达成明确共识。本研究旨在回顾我们在转移性 PTC 方面的经验，并确定侧颈部淋巴结转移的模式。
方法
回顾性分析 2004 年 1 月至 2011 年期间在我院接受侧颈部清扫术（II-Vb 水平）治疗的 PTC 患者的病历。共有 185 例患者接受了 248 例选择性侧颈部清扫术。
结果
II 水平、III 水平、IV 水平和 Vb 水平分别受累于 49.3%、76.6%、61.6%和 29.2%的病例。
结论
我们主张对于任何侧颈部转移的 PTC，常规切除 II、III、IV 和 Vb 水平。虽然我们常规解剖了 IIb 水平，但如果没有临床、影像学或术中证据表明这些亚水平受累，可能适合省略其解剖以及 Va 水平。
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