中国实用外科杂志

中国实用外科杂志

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甲状腺微小癌淋巴结转移规律研究

范西红a，贺青卿a，庄大勇a，范子义a，郑鲁明a，李    霞b   

  1. 济南军区总医院 a.甲状腺乳腺外科 b.信息科，山东济南250031
  • 发布日期:2012-04-26

  • Published:2012-04-26

摘要：

目的    探讨甲状腺微小癌（TMC）颈淋巴结转移规律，指导TMC颈淋巴结的恰当处理。方法    回顾性分析济南军区总医院1999年1月至2010年5月行颈淋巴结清扫的117例TMC病人颈淋巴结转移情况，分析TMC局部淋巴结转移的特点、影响因素、诊断方法及处理意见。结果    淋巴结转移发生率53.8%（63/117）。常见颈部淋巴结转移部位依次为Ⅵ区（47.9%）、Ⅲ区（20.9%）、Ⅳ区（16.5%）、Ⅱ区（6.1%）。随Ⅵ区淋巴结转移个数增多，侧方淋巴结转移递增。肿瘤数目、大小不同淋巴结转移发生率差异有统计学意义（P=0.000，P=0.014）。超声检查判断淋巴结有无转移的敏感度、特异度和准确率分别为19.0%、98.1%和55.5%。术中淋巴结快速病理检查有13.8%假阴性。全组无复发、转移和死亡。结论    TMC区域淋巴结转移发生率较高，应重视术前评估和术中快速活检，掌握TMC淋巴结转移特点，有助采取恰当手术方式，有选择的预防性区域性颈淋巴清扫可使病人获益。

关键词: 甲状腺微小癌, 淋巴结转移, 区域性颈淋巴结清扫

Abstract:

Metastatic rules and clinical significance of lymph nodes in thyroid minimal cancer        FAN Xi-hong*，HE Qing-qing，ZHUANG Da-yong，et al. *Department of Thyroid Breast Surgery, Jinan Military General Hospital, Jinan 250031, China
Corresponding author: FAN Xi-hong, E-mail:fxh1023@yahoo.com.cn
Abstract    Objective To investigate the metastatic rules of cervical lymph nodes in thyroid minimal cancer (TMC), and guide the appropriate treatments. Methods    Cervical lymph node metastasis of 117 cases of TMC performed  cervical lymph node dissection(CLND) from January 1999 to May 2010 in Jinan Military General Hospital was analyzed retrospectively. Characteristics, influencing factors, diagnosis methods and treatment suggestions in regional lymph nodes metastases were analyzed. Results    The rate of lymph nodes metastasis was 53.8%(63/117). The most common areas of cervical lymph nodes metastases was Ⅵ(47.9%), Ⅲ(20.9%), Ⅳ(16.5%), Ⅱ(6.1%)regions respectively. With the increasing of the number of lymph nodes metastases in Ⅵ region, the number of lateral lymph nodes metastases was also increased. Tumor number and size were related to the lymph nodes metastases (P=0.000，P=0.014). The ultrasonography estimates of the lymph nodes metastases sensitivity, specificity and accuracy was 19.0%, 98.1% and 55.5% respectively. The lymph nodes false negative rate was 13.8% by pathological examination in operation. There weren’t recurrences, metastases and deaths in all cases. Conclusion    The regional lymph nodes have high metastases rates in TMC cases. The preoperative evaluation, the intraoperative rapid biopsy and the characteristics of lymph nodes metastases in TMC should be stressed, which is more helpful in guiding clinical treatment. Preventive regional cervical lymph node dissection can  benefit the patients.

Key words: thyroid minimal cancer, lymph nodes metastases, regional cervical lymph node dissection