Noguchi S, Murakami N
Surg Clin North Am. 1987 Apr;67(2):251-61. doi: 10.1016/s0039-6109(16)44182-4.
The perithyroidal and ipsilateral cervical lymphatic system not only is commonly involved by thyroid cancer but also is a common site of recurrence. Modified radical neck dissection, with preservation of the sternocleidomastoid muscle and spinal accessory nerve, is the treatment of choice for patients with clinically evident lymph node metastases due to differentiated thyroid cancer. It is also recommended, by us, for patients over 40 years of age who have primary thyroid tumors greater than 1.5 cm in size whether or not nodes are clinically palpable. This is because at least 75 per cent of these patients have metastases, and their discernment at operation is unreliable. With more aggressive surgery, the recurrence-free survival rate can be improved substantially without cosmetic deformity or postoperative dysfunction.
甲状腺周围及同侧颈部淋巴系统不仅常被甲状腺癌累及，也是常见的复发部位。保留胸锁乳突肌和副神经的改良根治性颈清扫术，是因分化型甲状腺癌出现临床明显淋巴结转移患者的首选治疗方法。我们也建议，对于年龄超过40岁、原发性甲状腺肿瘤大小超过1.5 cm的患者，无论临床上是否可触及淋巴结，均采用此方法。这是因为这些患者中至少75%有转移，而术中对其识别并不可靠。采用更积极的手术方式，可在不造成美容畸形或术后功能障碍的情况下，显著提高无复发生存率。
