CAJ | 학술논문

目的探讨择区性颈淋巴结清扫术在颈部高危临床颈淋巴结阴性(cN0)甲状腺癌患者中的应用价值.方法前瞻性分析2006年8月至2011年6月,中国医学科学院肿瘤医院头颈外科收治的63例颈部高危cN0甲状腺癌患者的临床资料.结果 63例患者均经病理证实为甲状腺乳头状癌,侧颈淋巴结隐性转移率为39.7％.单因素分析结果显示,63例患者术后病理检查甲状腺被膜侵犯患者的侧颈淋巴结隐性转移率为46.9％,而甲状腺被膜未侵犯患者的侧颈淋巴结隐性转移率为14.3％,差异有统计学意义(P=0.028).Ⅵ区淋巴结转移患者的侧颈淋巴结隐性转移率为54.3％,而Ⅵ区淋巴结阴性患者的侧颈淋巴结隐性转移率为21.4％,差异有统计学意义(P=0.008).原发灶肿瘤≥2 cm患者的侧颈淋巴结隐性转移率为41.4％,而原发灶肿瘤＜2 cm患者的侧颈淋巴结隐性转移率为38.2％ (P =0.803).术前超声检查发现侧颈淋巴结肿大,但不考虑转移的34例患者中,17例出现隐性淋巴结转移,转移率为50.0％,而侧颈淋巴结术前超声检查阴性患者的隐性淋巴结转移率为27.6％ (P =0.072).多因素Logistic回归分析结果显示,仅Ⅵ区淋巴结转移与侧颈淋巴结隐性转移有关(P=0.017).而原发灶肿瘤被膜侵犯、原发肿瘤大小和术前超声检查侧颈淋巴结状态与侧颈淋巴结隐性转移无关(均P ＞0.05).结论择区性颈淋巴结清扫术对颈部高危的cN0甲状腺癌患者是可行的,能及时发现和清除侧颈隐性淋巴结的转移.建议对甲状腺被膜侵犯和Ⅵ区淋巴结转移的cN0甲状腺癌患者,常规行颈部Ⅲ、Ⅳ区淋巴结清扫.
목적 탐토택구성경림파결청소술재경부고위림상경림파결음성(cN0)갑상선암환자중적응용개치.방법 전첨성분석2006년8월지2011년6월,중국의학과학원종류의원두경외과수치적63례경부고위cN0갑상선암환자적림상자료.결과 63례환자균경병리증실위갑상선유두상암,측경림파결은성전이솔위39.7％.단인소분석결과현시,63례환자술후병리검사갑상선피막침범환자적측경림파결은성전이솔위46.9％,이갑상선피막미침범환자적측경림파결은성전이솔위14.3％,차이유통계학의의(P=0.028).Ⅵ구림파결전이환자적측경림파결은성전이솔위54.3％,이Ⅵ구림파결음성환자적측경림파결은성전이솔위21.4％,차이유통계학의의(P=0.008).원발조종류≥2 cm환자적측경림파결은성전이솔위41.4％,이원발조종류＜2 cm환자적측경림파결은성전이솔위38.2％ (P =0.803).술전초성검사발현측경림파결종대,단불고필전이적34례환자중,17례출현은성림파결전이,전이솔위50.0％,이측경림파결술전초성검사음성환자적은성림파결전이솔위27.6％ (P =0.072).다인소Logistic회귀분석결과현시,부Ⅵ구림파결전이여측경림파결은성전이유관(P=0.017).이원발조종류피막침범、원발종류대소화술전초성검사측경림파결상태여측경림파결은성전이무관(균P ＞0.05).결론 택구성경림파결청소술대경부고위적cN0갑상선암환자시가행적,능급시발현화청제측경은성림파결적전이.건의대갑상선피막침범화Ⅵ구림파결전이적cN0갑상선암환자,상규행경부Ⅲ、Ⅳ구림파결청소.
Objective To investigate the significance of selective neck dissection in patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis.Methods Sixty three patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis were prospectively studied at the Department of Head and Neck Surgery,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College between August 2006 and June 2011.The patients with cN0 thyroid carcinoma easy to occur neck lymph node metastasis include:The maximum diameter of primary tumor is ≥ 2 cm; The primary tumor invaded the thyroid capsule; Lymph node metastasis in level Ⅵ is found; Lymph node enlargement in level Ⅲ or/and Ⅳ were detected preoperatively by ultrasonography,but not considered as metastasis.The surgical procedure is that the selective neck dissection in level Ⅲ and Ⅳ is performed depending on the collar incision of thyroid surgery.The lymph node chosen from the specimen has a frozen section.If lymph node metastasis is found in the frozen section,a functional neck dissection should be performed through prolonging the collar incision.Results All cases were pathologically confirmed as thyroid papillary carcinoma.The occult metastasis rate of lateral neck lymph nodes was 39.7％.According to the univariate analysis,the patients with thyroid capsule invasion and lymph node metastasis in level Ⅵ were more likely to have lateral neck lymph node metastasis,and the occult metastasis rate was 46.9％ and 54.3％,respectively (P =0.028,P =0.008),and there were statistically no significant difference in the primary tumor size and the preoperative neck lymph node status by ultrasonography with occult metastasis of lateral neck lymph nodes (P =0.803 and P =0.072).According to the multivariate analysis,there was a significant correlation only between the lymph node metastasis in level Ⅵ and occult metastasis of lateral neck lymph nodes (P =0.017),but there was no significant correlation with the thyroid capsule invasion,primary tumor size and neck lymph node status by preoperative ultrasonography in prediction of occult metastasis of lateral neck lymph nodes (all P ＞ 0.05).Conclusions Selective neck dissection is feasible for the patients with cN0 thyroid carcinoma who have a high-risk lateral neck lymph node metastasis and the lateral occult metastatic lymph node can be promptly found and removed.We suggest that the selective neck dissection for level Ⅲ and Ⅳ should be routinely performed in cN0 thyroid carcinoma patients with thyroid capsule invasion and lymph node metastasis in level Ⅵ.