CAJ | 학술논문

目的探讨CN0期甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结的转移规律及合理的手术方式.方法回顾性分析2008年2月至2011年2月吉林大学第一医院收治的450例CN0期PTC的临床资料.结果 pN+219例(48.67％),pN0231例(51.33％).转移淋巴结的分布以Ⅵ区最常见,为46.22％ (208/450)(单侧甲癌41.08％,双侧甲癌58.09％)；其次是Ⅱa、Ⅲ、Ⅳ区:分别为4.44％(20/450),6.00％(27/450),8.89％(40/450),Vb区较少淋巴结转移,为2.22％(10/450),而Ⅰ区清扫2例均未见转移.当肿瘤直径≥1.0 cm、侵犯包膜或多灶性、男性、年龄＜45岁者,淋巴结转移发生率明显增加(P＜0.05).另外,肿瘤位于甲状腺上极者,患侧33.57％(48/143)Ⅱa、Ⅲ、Ⅳ区淋巴结发生转移；肿瘤位于甲状腺下极,对侧Ⅵ区10.48％ (13/124)发生转移.结论 PTC最常发生Ⅵ区淋巴结转移,其次为Ⅱa、Ⅲ、Ⅳ区,建议初次手术常规清扫Ⅵ区淋巴结.当肿块直径≥1.0 cm、肿瘤侵犯甲状腺包膜或Ⅵ区淋巴结转移超过3枚以上时,应适当扩大淋巴结清扫的范围(Ⅱa～Ⅳ区).肿瘤位于甲状腺下极时,建议清扫对侧Ⅵ区淋巴结；位于甲状腺上极时,建议清扫患侧Ⅱa、Ⅲ、Ⅳ区的淋巴结.
목적 탐토CN0기갑상선유두상암(papillary thyroid carcinoma,PTC)경부림파결적전이규률급합리적수술방식.방법 회고성분석2008년2월지2011년2월길림대학제일의원수치적450례CN0기PTC적림상자료.결과 pN+219례(48.67％),pN0231례(51.33％).전이림파결적분포이Ⅵ구최상견,위46.22％ (208/450)(단측갑암41.08％,쌍측갑암58.09％)；기차시Ⅱa、Ⅲ、Ⅳ구:분별위4.44％(20/450),6.00％(27/450),8.89％(40/450),Vb구교소림파결전이,위2.22％(10/450),이Ⅰ구청소2례균미견전이.당종류직경≥1.0 cm、침범포막혹다조성、남성、년령＜45세자,림파결전이발생솔명현증가(P＜0.05).령외,종류위우갑상선상겁자,환측33.57％(48/143)Ⅱa、Ⅲ、Ⅳ구림파결발생전이；종류위우갑상선하겁,대측Ⅵ구10.48％ (13/124)발생전이.결론 PTC최상발생Ⅵ구림파결전이,기차위Ⅱa、Ⅲ、Ⅳ구,건의초차수술상규청소Ⅵ구림파결.당종괴직경≥1.0 cm、종류침범갑상선포막혹Ⅵ구림파결전이초과3매이상시,응괄당확대림파결청소적범위(Ⅱa～Ⅳ구).종류위우갑상선하겁시,건의청소대측Ⅵ구림파결；위우갑상선상겁시,건의청소환측Ⅱa、Ⅲ、Ⅳ구적림파결.
Objective To discuss the metastasis principle of cervical lymph nodes in CN0 papillary thyroid carcinoma(PTC) and to define the proper surgery scope.Methods Clinical data of the 450 cases of CN0 PTC patients undergoing surgery from Feb.2008 to Feb.2011 in the First Hospital,Jilin University were retrospectively analyzed.Results There were 219 (48.67％) pN + cases and 231 (51.33 ％) pN0 cases.In CN0 PTC cases,lymph node metastasis was most commonly detected in area Ⅵ,about 46.22％ (208/450) (unilateral cancer 41.08％,bilateral cancer 58.09％).The lymph node metastasis rate was 4.44％ (20/450),6.00％ (27/450),and 8.89％ (40/450)respectively in area IIa,area Ⅲ,and area Ⅳ.The metastasis of lymph node was rare in Vb area,only about 2.22 ％ (10/450).No metastasis was found in the 2 cases undergoing area I lymph node dissection.When the tumor diameter was no less than 1.0 cm,capsule invaded or multifocal,male,＜ 45 years old,lymph node metastasis rate was significantly increased (P ＜ 0.05).In addition,when the tumor was located at the upper pole of the thyroid,the lymph node metastasis rate was 33.57％ (48/143) in Ⅱa,Ⅲ,Ⅳ areas in the affected side.When the tumor was at the lower pole of the thyroid,the lymph node metastasis rate was 10.48％ (13/124)in the contralateral area Ⅵ.Conclusion Lymph node metastasis occurs most commonly in area Ⅵ in PTC,followed by area Ⅱ a,area Ⅲ,area Ⅳ.Routine lymph node dissection in area Ⅵ is recommended for the initial surgery.When the tumor diameter is ≥ 1.0 cm,thyroid capsule invasion is involved or more than 3 metastasized lymph nodes were found in area Ⅵ,the range of lymph node dissection should properly be expanded to area Ⅱa-Ⅳ.When the tumor is located at the lower pole of the thyroid,area Ⅵ in the contralateral side should be cleaned.If the tumor is located at the upper pole of the thyroid,area Ⅱa,Ⅲ,Ⅳ in the affected side should be cleaned.