Gimm O, Rath F W, Dralle H
Department of General Surgery, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
Br J Surg. 1998 Feb;85(2):252-4. doi: 10.1046/j.1365-2168.1998.00510.x.
Incidence and pattern of lymph node metastasis (LNM) were evaluated in 35 patients who underwent primary surgery for papillary thyroid carcinoma.
Total thyroidectomy with systematic cervicocentral lymphadenectomy was performed routinely. Additionally, 22 patients underwent lymphadenectomy of the ipsilateral cervicolateral compartment. Sternotomy was performed in four patients.
Primary tumour status was: pT1, n = 7; pT2, n = 12; pT3, n = 4; pT4, n = 12. Twenty-four patients had LNM in the ipsilateral cervicocentral compartment (pT1, n = 2; pT2, n = 8; pT3, n = 4; pT4, n = 10). Nineteen had LNM in the ipsilateral cervicolateral compartment (pT1, n = 4; pT2, n = 6; pT3, n = 2; pT4, n = 7). Contralateral cervicocentral LNM was restricted to patients with pT3 tumours (n = 2) or pT4 tumours (n = 3). No patient had LNM in the contralateral cervicolateral compartment. Only one patient (pT3 tumour) had mediastinal LNM.
The cervicocentral compartment was most commonly involved with metastases, although the ipsilateral cervicolateral compartment was almost as often affected. In some patients ipsilateral cervicolateral LNM was present in the absence of cervicocentral LNM. Contralateral cervicolateral and upper mediastinal LNM, however, were rare. This study helps to plan radical surgery for papillary thyroid carcinoma.
对35例行甲状腺乳头状癌初次手术的患者的淋巴结转移（LNM）发生率及模式进行了评估。
常规行全甲状腺切除术及系统性颈中央区淋巴结清扫术。此外，22例患者行同侧颈外侧区淋巴结清扫术。4例患者行胸骨切开术。
原发肿瘤情况为：pT1，n = 7；pT2，n = 12；pT3，n = 4；pT4，n = 12。24例患者同侧颈中央区有LNM（pT1，n = 2；pT2，n = 8；pT3，n = 4；pT4，n = 10）。19例患者同侧颈外侧区有LNM（pT1，n = 4；pT2，n = 6；pT3，n = 2；pT4，n = 7）。对侧颈中央区LNM仅限于pT3肿瘤患者（n = 2）或pT4肿瘤患者（n = 3）。无患者对侧颈外侧区有LNM。仅1例患者（pT3肿瘤）有纵隔LNM。
颈中央区最常发生转移，尽管同侧颈外侧区受影响的频率几乎相同。在一些患者中，同侧颈外侧区LNM在无颈中央区LNM的情况下出现。然而，对侧颈外侧区和上纵隔LNM很少见。本研究有助于规划甲状腺乳头状癌的根治性手术。
