CAJ | 학술논문

目的探讨cNo期甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结状况及其与肿瘤复发及预后的关系.方法对1986-1990年收治的498例cNo PTC患者的临床、病理及随访资料进行回顾性分析.结果所有患者均获得10年以上的随访.498例患者16例死于本癌,其中13例因癌局部复发致死,而死于远处器官转移的仅3例.498例总颈淋巴结转移率为52.2％,其中260例患者的转移率分别为Ⅱ区14.1％、Ⅲ区27.1％、Ⅳ区24.6％、Ⅴ区12.5％、Ⅵ区20.1％.癌灶无包膜组淋巴结转移率为65.6％、侵出包膜组为64.5％、侵出腺叶组为56.5％、侵犯邻近组织组为52.0％、局灶癌变组为33.3％、隐性硬化型组为26.9％,包膜内和侵犯包膜组为0.全颈淋巴结清扫术后复发率为2％,中央区淋巴结清扫术后的复发率为9.9％.结论本组患者死亡的主要原因是局部复发,我们建议对属于侵袭性较强的病理类型的cNo PTC患者,如病理检查发现癌已经侵出包膜、侵出腺叶、侵犯邻近组织和无包膜,应考虑行预防性功能性全颈淋巴结清扫术.
목적 탐토cNo기갑상선유두상암(papillary thyroid carcinoma,PTC)경부림파결상황급기여종류복발급예후적관계.방법 대1986-1990년수치적498례cNo PTC환자적림상、병리급수방자료진행회고성분석.결과 소유환자균획득10년이상적수방.498례환자16례사우본암,기중13례인암국부복발치사,이사우원처기관전이적부3례.498례총경림파결전이솔위52.2％,기중260례환자적전이솔분별위Ⅱ구14.1％、Ⅲ구27.1％、Ⅳ구24.6％、Ⅴ구12.5％、Ⅵ구20.1％.암조무포막조림파결전이솔위65.6％、침출포막조위64.5％、침출선협조위56.5％、침범린근조직조위52.0％、국조암변조위33.3％、은성경화형조위26.9％,포막내화침범포막조위0.전경림파결청소술후복발솔위2％,중앙구림파결청소술후적복발솔위9.9％.결론 본조환자사망적주요원인시국부복발,아문건의대속우침습성교강적병리류형적cNo PTC환자,여병리검사발현암이경침출포막、침출선협、침범린근조직화무포막,응고필행예방성공능성전경림파결청소술.
Objective To explore the relationship between the status of the cervical lymphatic metastasis of papillary thyroid carcinoma(PTC)at cNo stage and tumor recurrence and the patient' s prognosis.Methods The clinical data of 498 cNo PTC patients admitted from 1986 to 1990 were retrospectively analyzed.Results All the patients were followed up for more than 10 years.16 patients died of PTC,among them 3 for metastasis,13 for local recurrence.The total cervical lymphatic metastasis rate in these 498 patients was 52.2％,in 260 cases in which detailed data were available: rate was 14.1％ in zone Ⅱ,27.1％ in zone Ⅲ,24.6％ in zone Ⅳ,12.5％ in zone Ⅴ,and 20.1％ in zone Ⅵ respectively.According to the appearances of microscopic pathology,the cervical lymphatic metastasis rates in 498 cases of cNo PTC were collected as following: uncapsuled group was 65.6％,extracapsular group was 64.5％,extralobal group was 56.5％,involved the surrounding tissue and structure group was 52.0％,focal cancerous focus group was 33.3％,latent sclerosis group was 26.9％,encapsuled and introcapsule group was 0.The cervical recurrence rate was only 2％ in the complete function neck dissection group and 9.9％ in the selective center neck dissection group.Conclusions In cNo PTC the most common cause of death was local recurrence.Prophylactic function complete neck dissection should be performed for cNo PTC cases of highly invasive type such as without tumor capsule,extracapsular,extralobal or surrounding tissue invasion.