中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
6期
449-451
,共3页
甲状腺肿瘤%癌,乳头状%甲状腺切除术%颈淋巴结清扫术
甲狀腺腫瘤%癌,乳頭狀%甲狀腺切除術%頸淋巴結清掃術
갑상선종류%암,유두상%갑상선절제술%경림파결청소술
Thyroid neoplasms%Carcinoma,papillary%Thyroidectomy%Neck dissection
目的 探讨甲状腺乳头状癌德尔法淋巴结转移的临床价值.方法 前瞻性分析2008-2011年间首次手术的经冰冻病理证实为单发甲状腺乳头状癌86例患者及其德尔法淋巴结是否有肿瘤转移.将德尔法淋巴结转移与患者的临床和病理学因素包括年龄、性别、肿瘤大小、甲状腺被膜侵犯以及中央和侧方淋巴结转移做相关性分析.结果 本组所有患者均行患侧甲状腺全切+对侧甲状腺次全切+中央区域淋巴结清扫,并同时行Ⅲ和Ⅳ区域淋巴结清扫.术后均恢复良好,无喉返神经麻痹及永久性甲状旁腺功能减退等严重并发症发生.随访率91.9％ (79/86),中位随访时间45个月,均未发现肿瘤复发和转移.德尔法淋巴结阳性不仅与原发性肿瘤被膜侵犯有关(60％比24％,P=0.019),而且与中央(80％比27％,P＜0.001)和侧方(40％比5％,P＜0.001)区域淋巴结转移有关.德尔法淋巴结阳性也与转移的淋巴结数(平均7比2个淋巴结；P =0.002)以及淋巴结大小(2.1 cm比0.8 cm,P =0.002)有关.结论 德尔法淋巴结转移与甲状腺癌的被膜侵犯有关,德尔法淋巴结阳性者颈部中央和侧方淋巴结转移发生率会明显增加,术中应仔细探查中央和侧方区域淋巴结.
目的 探討甲狀腺乳頭狀癌德爾法淋巴結轉移的臨床價值.方法 前瞻性分析2008-2011年間首次手術的經冰凍病理證實為單髮甲狀腺乳頭狀癌86例患者及其德爾法淋巴結是否有腫瘤轉移.將德爾法淋巴結轉移與患者的臨床和病理學因素包括年齡、性彆、腫瘤大小、甲狀腺被膜侵犯以及中央和側方淋巴結轉移做相關性分析.結果 本組所有患者均行患側甲狀腺全切+對側甲狀腺次全切+中央區域淋巴結清掃,併同時行Ⅲ和Ⅳ區域淋巴結清掃.術後均恢複良好,無喉返神經痳痺及永久性甲狀徬腺功能減退等嚴重併髮癥髮生.隨訪率91.9％ (79/86),中位隨訪時間45箇月,均未髮現腫瘤複髮和轉移.德爾法淋巴結暘性不僅與原髮性腫瘤被膜侵犯有關(60％比24％,P=0.019),而且與中央(80％比27％,P＜0.001)和側方(40％比5％,P＜0.001)區域淋巴結轉移有關.德爾法淋巴結暘性也與轉移的淋巴結數(平均7比2箇淋巴結；P =0.002)以及淋巴結大小(2.1 cm比0.8 cm,P =0.002)有關.結論 德爾法淋巴結轉移與甲狀腺癌的被膜侵犯有關,德爾法淋巴結暘性者頸部中央和側方淋巴結轉移髮生率會明顯增加,術中應仔細探查中央和側方區域淋巴結.
목적 탐토갑상선유두상암덕이법림파결전이적림상개치.방법 전첨성분석2008-2011년간수차수술적경빙동병리증실위단발갑상선유두상암86례환자급기덕이법림파결시부유종류전이.장덕이법림파결전이여환자적림상화병이학인소포괄년령、성별、종류대소、갑상선피막침범이급중앙화측방림파결전이주상관성분석.결과 본조소유환자균행환측갑상선전절+대측갑상선차전절+중앙구역림파결청소,병동시행Ⅲ화Ⅳ구역림파결청소.술후균회복량호,무후반신경마비급영구성갑상방선공능감퇴등엄중병발증발생.수방솔91.9％ (79/86),중위수방시간45개월,균미발현종류복발화전이.덕이법림파결양성불부여원발성종류피막침범유관(60％비24％,P=0.019),이차여중앙(80％비27％,P＜0.001)화측방(40％비5％,P＜0.001)구역림파결전이유관.덕이법림파결양성야여전이적림파결수(평균7비2개림파결；P =0.002)이급림파결대소(2.1 cm비0.8 cm,P =0.002)유관.결론 덕이법림파결전이여갑상선암적피막침범유관,덕이법림파결양성자경부중앙화측방림파결전이발생솔회명현증가,술중응자세탐사중앙화측방구역림파결.
Objective To explore the clinical value of Delphian node (DN) metastasis in papillary thyroid cancer(PTC).Method In this study,86 cases of unilateral PTC proved by frozen pathology and initially undergoing surgical treatment were enrolled to evaluate Delphian nodes metastasis in its correlation with age,sex,tumor size,extra-thyroid extension and central and lateral compartment nodes.Results All patients underwent homolateral thyroidectomy plus contralateral subtotal thyroidectomy,central compartment and region Ⅲ and Ⅳ lymphadenectomy.There were no mortality and major morbidities.The following-up rate was 91.9％ (79/86).The mean following-up time was 45 months,and there was no tumor recurrence and metastasis.DN-postive was in close relation to extra-thyroid extension ( 60％ vs.24％ ;P =0.019)positive central compartment ( 80％ vs.27％ ;P ＜ 0.01 ) and lateral compartment lymph node metastasis (40％ vs.5％ ;P ＜ 0.01 ).DN-postive was also in close relation to the number of metastastic nodes ( average 7 vs.2 numbers of node;P =0.002 ) and the size of the node (2.1 cm vs.0.8 cm;P =0.02).Conclusions DN-postive has close relationship with extra-thyroid extension and central and lateral compartment nodes in PTC patients.
