CAJ | 학술논문

目的探讨甲状腺乳头状癌cNO患者颈侧区淋巴结转移状况及规律.方法回顾性分析106例甲状腺乳头状癌cNO患者的临床及病理资料.所有患者均为首次手术,手术方式均为甲状腺全切除或近全切除+中央区淋巴清扫+颈侧区淋巴清扫.分析指标包括患者性别、年龄、原发灶大小、肿瘤是否多发、肿瘤T分级及中央区淋巴结转移状况,同时对肿瘤原发灶位置与颈侧区淋巴结转移区域的关系进行探讨.结果 cNO甲状腺乳头状癌颈侧区淋巴结转移与男性(P=0.007)、原发灶最大径＞1 cm(P =0.014)、肿瘤T分级为T3、T4 (P=0.006)及中央区淋巴结阳性数≥2枚(P＜0.001)有关,而与年龄(P =0.947)及肿瘤是否多发(P =0.710)无关.颈侧区淋巴转移以Ⅲ区(47/116,40.5％)、Ⅳ区(41/116,35.3％)最常见,其次是Ⅱ区(18/116,15.5％),而Ⅴ区转移少见(2/29,6.9％).其中89.8％(79/88)的Ⅲ、Ⅳ区淋巴转移发生于原发灶位于(或包含)甲状腺中下极的患者,77.8％ (14/18)的Ⅱ区淋巴转移发生于原发灶位于(或包含)甲状腺上极的患者,83.3％(15/18)的Ⅱ区转移同时伴随着Ⅲ区转移.2例Ⅴ区淋巴转移的患者都伴有Ⅱ、Ⅲ、Ⅳ区同时转移.结论对于男性、肿瘤为T3、T4级及中央区淋巴结阳性数≥2枚的甲状腺乳头状癌患者建议术中常规清扫颈侧Ⅲ、Ⅳ区淋巴结,如肿瘤位于甲状腺上极或Ⅲ区淋巴结阳性者还应清扫Ⅱ区,只有当Ⅱ、Ⅲ、Ⅳ区同时有淋巴转移时才应考虑Ⅴ区淋巴清扫术.对于肿瘤最大径≤1 cm且局限于甲状腺内及无中央区淋巴转移的甲状腺乳头状癌患者不建议行预防性颈侧区淋巴清扫术.
목적 탐토갑상선유두상암cNO환자경측구림파결전이상황급규률.방법 회고성분석106례갑상선유두상암cNO환자적림상급병리자료.소유환자균위수차수술,수술방식균위갑상선전절제혹근전절제+중앙구림파청소+경측구림파청소.분석지표포괄환자성별、년령、원발조대소、종류시부다발、종류T분급급중앙구림파결전이상황,동시대종류원발조위치여경측구림파결전이구역적관계진행탐토.결과 cNO갑상선유두상암경측구림파결전이여남성(P=0.007)、원발조최대경＞1 cm(P =0.014)、종류T분급위T3、T4 (P=0.006)급중앙구림파결양성수≥2매(P＜0.001)유관,이여년령(P =0.947)급종류시부다발(P =0.710)무관.경측구림파전이이Ⅲ구(47/116,40.5％)、Ⅳ구(41/116,35.3％)최상견,기차시Ⅱ구(18/116,15.5％),이Ⅴ구전이소견(2/29,6.9％).기중89.8％(79/88)적Ⅲ、Ⅳ구림파전이발생우원발조위우(혹포함)갑상선중하겁적환자,77.8％ (14/18)적Ⅱ구림파전이발생우원발조위우(혹포함)갑상선상겁적환자,83.3％(15/18)적Ⅱ구전이동시반수착Ⅲ구전이.2례Ⅴ구림파전이적환자도반유Ⅱ、Ⅲ、Ⅳ구동시전이.결론 대우남성、종류위T3、T4급급중앙구림파결양성수≥2매적갑상선유두상암환자건의술중상규청소경측Ⅲ、Ⅳ구림파결,여종류위우갑상선상겁혹Ⅲ구림파결양성자환응청소Ⅱ구,지유당Ⅱ、Ⅲ、Ⅳ구동시유림파전이시재응고필Ⅴ구림파청소술.대우종류최대경≤1 cm차국한우갑상선내급무중앙구림파전이적갑상선유두상암환자불건의행예방성경측구림파청소술.
Objective To study the pattern of lymph node spread in papillary thyroid carcinoma (PTC) with clinically negative node(cN0).Methods A total of 106 patients with cN0 PTC who underwent total or subtoyal thyroidectomy plus unilateral or bilateral lateral neck dissection ( LND,level Ⅱ - Ⅴ or level Ⅰ - Ⅴ ) at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively.Results The lateral neck lymph node metastasis in cN0 PTC was significantly associated with sex ( male,P =0.007 ),tumor stage ( T3/T4,P =0.006 ),tumor size ( ＞ 1 cm,P =0.014) and the number of positive central lymph nodes( ≥2,P ＜0.001 ),but not with age and multifocal tumor.Level Ⅲ (47/116,40.5％ ) was the most prevalent metastatic site,followed by level Ⅳ (41/116,35.3％),level Ⅱ (18/116,15.5％) and level Ⅴ (2/29,6.9％).Of the cases with lymph node metastases in level Ⅲ and Ⅳ,89.8％ ( 79/88 ) of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes,while in the cases with lymph node metastases in level Ⅱ,77.8％ (14/18) of primary thyroid tumors in the upper sites of the thyroid lobes,and 83.3％ of cases with level Ⅱ metastases were accompanied with level Ⅲ metastases.Two cases with level Ⅴ metastases were accompanied with metastases in levels Ⅱ,Ⅲ and Ⅳ.Conclusions LND should be considered for cNO PTC in male,with T3/T4 lesions and positive central lymph nodes≥2,and the range of dissection should include level Ⅲ and Ⅳ.Dissection of level Ⅱ should be considered in cNO PTC with primary tumor localized in the upper site of the thyroid lobe or with level Ⅲ metastasis.Dissection of level Ⅴ should be considered at present of metastases in level Ⅱ,Ⅲ,and Ⅳ.For cN0 PTC with tumor size ＜ 1 cm,confined to the thyroid and without lymph node metastasis in the central compartment,LND is not recommended.