中国实用外科杂志

中国实用外科杂志

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甲状腺乳头状癌中央区淋巴结清扫术后复发临床研究

邵堂雷a，周    伟b，詹维伟a，杨卫平a   

  1. 上海交通大学医学院附属瑞金医院 a.普外科 b.超声诊断科，上海 200025
  • 出版日期:2015-01-01 发布日期:2014-12-31

  • Online:2015-01-01 Published:2014-12-31

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摘要：

目的    对甲状腺乳头状癌中央区淋巴结清扫术后淋巴结复发进行临床研究。方法    回顾性分析2011年1月至2013年12月间在上海交通大学医学院附属瑞金医院普外科手术治疗的38例病人临床资料。结果 行淋巴结再清扫的38例病理检查证实均有乳头状癌转移。其中34例位于原右侧中央区清扫区域，发生率为89.5%，4例（10.5%）位于原左侧中央区清扫区域。右侧复发者淋巴结位于右颈总动脉深面的气管右侧、右喉返神经内侧和右肺尖上方所构成的三角内，左侧复发者淋巴结位于锁骨深面的气管左侧和左颈总动脉之间。术后7例（18.4%）出现暂时性声音嘶哑，1例（2.6%）出现永久性喉返神经损伤。6例（6/38，15.8%）出现暂时性低钙血症。结论    再次清扫中央区淋巴结风险大，因此，首次清扫务必彻底和规范。特别不要遗漏斜行的右颈总动脉深面，位于气管右侧、右喉返神经内侧和右肺尖上方的这一区域。

关键词: 甲状腺乳头状癌, 中央区淋巴结, 复发

Abstract:

Clinical study of the recurrence of the central lymph node after central lymph node dissection in papillary thyroid carcinoma        SHAO Tang-lei*，ZHOU Wei,ZHAN Weiwei,et al.  *Department of General Surgery, Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China
Corresponding author:YANG Wei-ping,E-mail:yangweipingmd@126.com
Abstract    Objective    To study the reason of the recurrence of the central lymph node after central lymph node dissection in papillary thyroid carcinoma.Methods    The clinical data of 38 cases from January 2011 to December 2013 at our department were analyzed retrospectively.Results    All central lymph nodes percured in the second operation were proved with metastasis by pathology in all cases.34 cases (89.7%)of all were located in former right central lymph node area,and 4 cases(10.5%) of all were located in former left central lymph node area.The recurrent central lymph node in right side was located among trachea,right recurrent laryngeal nerve and apex of lung beneath right carotid artery. The recurrent central lymph node in left side was located between trachea and left carotid artery beneath calvicle. The rate of transient vocal hoarseness and permanent recurrent laryngeal nerve injury was 18.4% and 2.6% respectively.The rate of transient hypocalcemia was 15.8%.Conclusion    Because of the high injury rate of recurrent laryngeal nerve and parathyroid in the second central lymph node dissection,We suggested that the first central lymph node dissection should be performed thoroughly,especially not leaving out the area among trachea,right recurrent laryngeal nerve and apex of lung beneath the oblique right carotid artery.

Key words: papillary thyroid carcinoma, central lymph node, recurrence