乳头状甲状腺癌的颈部淋巴结转移规律与手术方式
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黄韬

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The regularity of cervical lymph node metastasis of papillary thyroid cancer and selection of surgical procedure
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    目的:探讨甲状腺乳头状癌颈部淋巴结的转移规律以及清扫范围的合理选择。方法:回顾性分析近4年多来收治的457例乳头状甲状腺癌患者的临床资料。结果:全组患者均接受常规甲状腺双侧全切加颈深(Ⅲ+Ⅳ区)组及中央(Ⅵ区)组颈部淋巴结清扫术。颈部淋巴结总转移发生率为63.67 %(291/457),中央组淋巴结转移发生率为 59.08%(270/457),颈深组淋巴结转移发生率为29.76%(136/457)。当癌肿直径>1 cm或癌肿突破甲状腺包膜、侵犯肌肉时各区淋巴结转移的发生率明显增加(P<0.05)。全组无手术或住院期间死亡。结论:乳头状甲状腺癌最常见的淋巴结转移为中央组淋巴结,其次为颈深组(Ⅲ+Ⅳ区)的淋巴结,初次手术应常规清扫双侧中央组淋巴结,当肿块直径>1 cm或癌肿突破甲状腺包膜和/或侵犯肌肉时宜同时,清扫同侧的颈深组淋巴结。

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    Objective:To study the regularity of cervical lymph metastasis of papillary thyroid cancer and select a reasonable extent of lymph node dissection.Methods :Clinical data of 457 papillary thyroid cancer patients at our hospital between Jun,2003 and Sep,2007 were retrospectively reviewed.Results:All patients routinely underwent bilateral thyroidectomy and deep and central cervical lymph node dissection (Ⅲ,Ⅳ+Ⅵ region). The total rate of cervical lymph node metastasis was 63.67 %(291/457), metastases that occurred in central region and deep jugular lymph nodes was 59.08% (270/457) and 29.76% (136/457),respectively.The rate of cervical lymph node metastasis was markedly increased with diameter of primary neoplasm>1 cm or tumor penetrating through the thyroid capsule (P<0.05).Conclusions:For papillary thyroid cancer,the most common cervical lymph node metastasis is the central region,then the deep jugular(Ⅲ+Ⅳ region) lymph nodes.For primary operation, it is necessary to routinely dissect the bilateral central lymph nodes,and it is reasonable to dissect the ipsilateral deep jugular lymph nodes when diameter of primary neoplasm is >1 cm or tumor penetrate through the thyroid capsule.

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李治, 刘春萍, 屈新才, 黄韬.乳头状甲状腺癌的颈部淋巴结转移规律与手术方式[J].中国普通外科杂志,2008,17(11):1-105.
DOI:10.7659/j. issn.1005-6947.2008.11.001

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  • 在线发布日期: 2008-11-25