中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
2期
109-114
,共6页
张品一%张滨%卜建龙%刘垚%张伟峰
張品一%張濱%蔔建龍%劉垚%張偉峰
장품일%장빈%복건룡%류요%장위봉
甲状腺肿瘤%淋巴转移%颈淋巴结清扫术%右侧喉返神经深层淋巴结%危险因素
甲狀腺腫瘤%淋巴轉移%頸淋巴結清掃術%右側喉返神經深層淋巴結%危險因素
갑상선종류%림파전이%경림파결청소술%우측후반신경심층림파결%위험인소
Thyroid neoplasms%Lymphatic metastasis%Neck dissection%Lymph node posterior to right recurrent laryngeal nerve%Risk factors
目的 探讨甲状腺乳头状癌(PTC)右侧喉返神经深层淋巴结(LN-prRLN)转移的危险因素与手术适应证.方法 对2010年1月至2012年1月期间接受手术治疗的283例PTC患者进行前瞻性临床研究,手术均切除肿瘤腺叶并常规行同侧中央区淋巴结清扫(CLND).将右侧中央区气管旁淋巴结以喉返神经(RLN)为界,分为浅层(Ⅵa亚区)与深层(Ⅵb亚区,即LN-prRLN)两部分,分别清除后进行病理检查,记录术后并发症及复发情况.结果 283例PTC患者中,中央区淋巴结(CCLN)转移率为47.7％(135/283),Ⅵb亚区淋巴结转移率为27.2％ (77/283),Ⅵa和Ⅵb亚区淋巴结同时转移率为20.5％ (58/283),伴Ⅵa亚区阴性的Ⅵb亚区淋巴结转移率为6.7％(19/283).Ⅵb亚区淋巴结清扫的相关并发症发生率为4.9％(14/283),术后3年内局部复发率为2.1％ (6/283).单因素分析显示,肿瘤大小、肿瘤数量、肿瘤侵袭程度、Ⅵa亚区淋巴结转移情况、颈侧区淋巴结转移情况和临床淋巴结分期与Ⅵb亚区淋巴结转移有关(P ＜0.001).多因素分析显示,肿瘤大小、肿瘤数量、肿瘤侵袭程度、Ⅵa亚区淋巴结转移情况和颈侧区淋巴结转移情况是影响PTC患者Ⅵb亚区淋巴结转移的独立因素.结论 PTC发生右侧CCLN转移可仅累及RLN深层而无浅层转移.因此,右侧CLND应常规探查RLN深层区域.当右侧PTC肿瘤直径≥1 cm、多发肿瘤、伴甲状腺外侵袭或颈淋巴结转移时,完整的CLND应包含LN-prRLN清除.
目的 探討甲狀腺乳頭狀癌(PTC)右側喉返神經深層淋巴結(LN-prRLN)轉移的危險因素與手術適應證.方法 對2010年1月至2012年1月期間接受手術治療的283例PTC患者進行前瞻性臨床研究,手術均切除腫瘤腺葉併常規行同側中央區淋巴結清掃(CLND).將右側中央區氣管徬淋巴結以喉返神經(RLN)為界,分為淺層(Ⅵa亞區)與深層(Ⅵb亞區,即LN-prRLN)兩部分,分彆清除後進行病理檢查,記錄術後併髮癥及複髮情況.結果 283例PTC患者中,中央區淋巴結(CCLN)轉移率為47.7％(135/283),Ⅵb亞區淋巴結轉移率為27.2％ (77/283),Ⅵa和Ⅵb亞區淋巴結同時轉移率為20.5％ (58/283),伴Ⅵa亞區陰性的Ⅵb亞區淋巴結轉移率為6.7％(19/283).Ⅵb亞區淋巴結清掃的相關併髮癥髮生率為4.9％(14/283),術後3年內跼部複髮率為2.1％ (6/283).單因素分析顯示,腫瘤大小、腫瘤數量、腫瘤侵襲程度、Ⅵa亞區淋巴結轉移情況、頸側區淋巴結轉移情況和臨床淋巴結分期與Ⅵb亞區淋巴結轉移有關(P ＜0.001).多因素分析顯示,腫瘤大小、腫瘤數量、腫瘤侵襲程度、Ⅵa亞區淋巴結轉移情況和頸側區淋巴結轉移情況是影響PTC患者Ⅵb亞區淋巴結轉移的獨立因素.結論 PTC髮生右側CCLN轉移可僅纍及RLN深層而無淺層轉移.因此,右側CLND應常規探查RLN深層區域.噹右側PTC腫瘤直徑≥1 cm、多髮腫瘤、伴甲狀腺外侵襲或頸淋巴結轉移時,完整的CLND應包含LN-prRLN清除.
목적 탐토갑상선유두상암(PTC)우측후반신경심층림파결(LN-prRLN)전이적위험인소여수술괄응증.방법 대2010년1월지2012년1월기간접수수술치료적283례PTC환자진행전첨성림상연구,수술균절제종류선협병상규행동측중앙구림파결청소(CLND).장우측중앙구기관방림파결이후반신경(RLN)위계,분위천층(Ⅵa아구)여심층(Ⅵb아구,즉LN-prRLN)량부분,분별청제후진행병리검사,기록술후병발증급복발정황.결과 283례PTC환자중,중앙구림파결(CCLN)전이솔위47.7％(135/283),Ⅵb아구림파결전이솔위27.2％ (77/283),Ⅵa화Ⅵb아구림파결동시전이솔위20.5％ (58/283),반Ⅵa아구음성적Ⅵb아구림파결전이솔위6.7％(19/283).Ⅵb아구림파결청소적상관병발증발생솔위4.9％(14/283),술후3년내국부복발솔위2.1％ (6/283).단인소분석현시,종류대소、종류수량、종류침습정도、Ⅵa아구림파결전이정황、경측구림파결전이정황화림상림파결분기여Ⅵb아구림파결전이유관(P ＜0.001).다인소분석현시,종류대소、종류수량、종류침습정도、Ⅵa아구림파결전이정황화경측구림파결전이정황시영향PTC환자Ⅵb아구림파결전이적독립인소.결론 PTC발생우측CCLN전이가부루급RLN심층이무천층전이.인차,우측CLND응상규탐사RLN심층구역.당우측PTC종류직경≥1 cm、다발종류、반갑상선외침습혹경림파결전이시,완정적CLND응포함LN-prRLN청제.
Objective To investigate the risk factors for metastasis and clinical indications tor dissection of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC).Methods A prospective analysis including 283 consecutive patients with PTC who underwent total thyroidectomy with routine central lymph node dissection (CLND) in our hospital from Jan.2010 to Jan.2012 was performed.The right paratracheal lymph nodes in the central compartment lymph nodes (CCLN) were divided into the anterior (level Ⅵa) and posterior (level Ⅵb) compartments by recurrent laryngeal nerve (RLN),and were removed respectively.The complications and recurrences were recorded with a follow-up of 3 months to 3 years.Results CCLN metastases were present in 47.7％ (135/283) of the patients,and level Ⅵb metastases were present in 27.2％ (77/283) of the patients.The incidence of level Ⅵ b metastasis was 20.5％ (58/283) in level Ⅵ a-positive patients,while 6.7％ (19/283) in level Ⅵ a-negative patients.Complications of level Ⅵ b dissection were found in 4.9％ (14/283) of all patients.2.1％ (6/283) of all patients were diagnosed with regional recurrence during the 3-year follow-up.Univariate analysis revealed that level Ⅵ b metastasis was significantly associated with tumor size,number,extrathyroidal invasion,clinical nodal stage,level Ⅵa and lateral lymph node metastases.Multivariate analysis revealed that tumor larger than 1 cm,multifocality,extrathyroidal invasion,level Ⅵ a and lateral lymph node metastases were independent risk factors for level Ⅵ b metastasis.Conclusions Lymph node posterior to right recurrent laryngeal nerve can be the only site of metastasis from PTC without other cervical compartment involvements.Therefore,routine intraoperative detection of these nodes may be necessary for patients with right PTC,and dissection should be considered when a right-side PTC tumor is larger than 1 cm,multifocality,with extrathyroidal invasion or cervical nodal metastases.
