Dralle H, Gimm O
Chirurg. 1996 Aug;67(8):788-806. doi: 10.1007/pl00002519.
The prognostic value of lymph node metastases in thyroid cancer has been a matter of controversy for many years. However, during the past decade most multivariate analyses have shown a prognostic influence of lymph node metastases in papillary as well as medullary thyroid carcinoma constituting the basis for a standardized concept of lymphadenectomy oriented to the lymph node classification of the UICC (1993). Due to the frequency of lymph node metastases in the ipsilateral cervicocentral compartment (42-86%), in the ipsilateral cervicolateral compartment (32-68%), in the contralateral cervicolateral compartment (12-24%), and in the mediastinal compartment (3-20%), these compartments can be defined as the lymph node regions of the first, second, third and fourth order, respectively. Cervicocentral systematic lymphadenectomy should be part of the en bloc resection of the thyroid gland and the first lymph node region in any thyroid cancer. Cervicolateral as well as mediastinal lymphadenectomy should be performed according to the extent of lymph node involvement, i.e. systematically when multiple lymph node metastases are present, otherwise selectively. One exception is in medullary thyroid carcinoma, where a four-compartment lymphadenectomy is recommended in any patient with positive lymph nodes. Performing a gentle technique using magnifying glasses and bipolar coagulation forceps, systematic lymphadenectomy does not increase the rate of complications, can decrease the recurrence rate and improve survival.
多年来，甲状腺癌中淋巴结转移的预后价值一直存在争议。然而，在过去十年中，大多数多因素分析表明，淋巴结转移对乳头状甲状腺癌和髓样甲状腺癌均有预后影响，这构成了基于国际抗癌联盟（UICC，1993年）淋巴结分类的标准化淋巴结清扫概念的基础。由于同侧颈中央区淋巴结转移发生率为42% - 86%，同侧颈外侧区为32% - 68%，对侧颈外侧区为12% - 24%，纵隔区为3% - 20%，这些区域可分别定义为第一、第二、第三和第四级淋巴结区域。在任何甲状腺癌中，颈中央区系统性淋巴结清扫都应是甲状腺腺叶及第一级淋巴结区域整块切除的一部分。颈外侧区及纵隔淋巴结清扫应根据淋巴结受累程度进行，即当存在多个淋巴结转移时进行系统性清扫，否则进行选择性清扫。髓样甲状腺癌是一个例外，对于任何有阳性淋巴结的患者，均建议进行四区淋巴结清扫。采用放大镜和双极电凝镊进行轻柔操作，系统性淋巴结清扫不会增加并发症发生率，可降低复发率并提高生存率。
