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1、第17卷第11期中國普通外科雜志Vol.17No.112008年11月ChineseJournalofGeneralSurgeryNov.2008文章編號:1005-6947(2008)11-1051-03·甲狀腺外科專題研究·乳頭狀甲狀腺癌的頸部淋巴結轉移規(guī)律與手術方式李治,劉春萍,屈新才,黃韜(華中科技大學附屬協(xié)和醫(yī)院乳腺甲狀腺外科,湖北武漢430022)摘要:目的探討甲狀腺乳頭狀癌頸部淋巴結的轉移規(guī)律以及清掃范圍的合理選擇。方法回顧性分析近4年多來收治的457例乳頭狀甲狀腺癌患者的臨床資料。結果全組患者均接受常
2、規(guī)甲狀腺雙側全切加頸深(Ⅲ+Ⅳ區(qū))組及中央(Ⅵ區(qū))組頸部淋巴結清掃術。頸部淋巴結總轉移發(fā)生率為63.67%(291/457),中央組淋巴結轉移發(fā)生率為59.08%(270/457),頸深組淋巴結轉移發(fā)生率為29.76%(136/457)。當癌腫直徑>1cm或癌腫突破甲狀腺包膜、侵犯肌肉時各區(qū)淋巴結轉移的發(fā)生率明顯增加(P<0.05)。全組無手術或住院期間死亡。結論乳頭狀甲狀腺癌最常見的淋巴結轉移為中央組淋巴結,其次為頸深組(Ⅲ+Ⅳ區(qū))的淋巴結,初次手術應常規(guī)清掃雙側中央組淋巴結,當腫塊直徑>1cm或癌腫突破甲狀腺包膜
3、和/或侵犯肌肉時宜同時,清掃同側的頸深組淋巴結。[中國普通外科雜志,2008,17(11):1051-1053]關鍵詞:甲狀腺腫瘤/外科學;癌,乳頭狀;淋巴結轉移;頸淋巴結清掃術中圖分類號:R736.1文獻標識碼:ATheregularityofcervicallymphnodemetastasisofpapillarythyroidcancerandselectionofsurgicalprocedureLIZhi,LIUChunping,QUXincai,HUANGTao(DepartmentofBreastan
4、dThyroidSurgery,UnionHospital,HuazhongUniversityofScienceandTechnology,Wuhan430022,China)Abstract:ObjectiveTostudytheregularityofcervicallymphmetastasisofpapillarythyroidcancerandselectareasonableextentoflymphnodedissection.MethodsClinicaldataof457papillarythyr
5、oidcancerpatientsatourhospitalbetweenJun,2003andSep,2007wereretrospectivelyreviewed.ResultsAllpatientsroutinelyunderwentbilateralthyroidectomyanddeepandcentralcervicallymphnodedissection(Ⅲ,Ⅳ+Ⅵregion).Thetotalrateofcervicallymphnodemetastasiswas63.67%(291/457),m
6、etastasesthatoccurredincentralregionanddeepjugularlymphnodeswas59.08%(270/457)and29.76%(136/457),respectively.Therateofcervicallymphnodemetastasiswasmarkedlyincreasedwithdiameterofprimaryneoplasm>1cmortumorpenetratingthroughthethyroidcapsule(P<0.05).Conclusions
7、Forpapillarythyroidcancer,themostcommoncervicallymphnodemetastasisisthecentralregion,thenthedeepjugular(Ⅲ+Ⅳregion)lymphnodes.Forprimaryoperation,itisnecessarytoroutinelydissectthebilateralcentrallymphnodes,anditisreasonabletodissecttheipsilateraldeepjugularlymp
8、hnodeswhendiameterofprimaryneoplasmis>1cmortumorpenetratethroughthethyroidcapsule.[ChineseJournalofGeneralSurgery,2008,17(11):1051-1053]Keywords:ThyroidNeoplasms/surg;Carcin
