中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

甲状腺微小癌中央区淋巴结清扫临床价值

王卓颖   

  1. 复旦大学附属肿瘤医院头颈外科，上海200032
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

甲状腺微小癌发病率逐年升高，对于中央区淋巴结清扫时机和范围的选择国内外观点有所差异，争议主要集中在中央区淋巴结无转移（cN0）病人是否须常规清扫中央区淋巴结。不支持常规清扫的观点主要基于在全甲状腺切除联合同位素治疗前提下预防性中央区清扫未改善整体预后，同时有增加手术并发症的风险。支持的观点主要基于中央区淋巴结转移发生率较高，常规清扫有助于增加局部控制率，减少复发后再次手术相关并发症的发生。随着指南中甲状腺原发灶切除范围和核素治疗指征的改变，常规中央区淋巴结清扫的重要性将逐步体现。而解决争议的关键在于提高中央区淋巴结转移的诊断准确率，根据病人复发危险因素进行个体化选择，规范专科化操作，从而提高治疗效果并同时减少并发症的发生。

关键词: 甲状腺微小癌, 中央区淋巴结, 颈淋巴结清扫

Abstract:

Central compartment lymph node dissection in thyroid microcarcinoma        WANG Zhuo-ying. Department of Head and Neck Surgery，Fudan University Shanghai Cancer Center，Shanghai 200032，China
Abstract    The incidence of thyroid microcarcinoma shows an upward trend in recent years. There are still some controversial in choice of central compartment lymph node dissection (CND) for those patients，especially the cN0 patients. The basis against prophylactic CND is no prognosis improvement after total thyroidectomy plus radioactive iodine ablation (RAI) with CND，but more complications. On the other hand, prophylactic CND may increase the local control rate due to high metastatic rates and avoid the complications related to secondary surgery. With the revised guidelines, prophylactic CND may play a more important role in thyroid microcarcinoma treatment. Regarding the two points of view，the optimal personalized choice of central compartment dissection should be base on the improvement of local control and lower operation related complications.

Key words: thyroid microcarcinoma, central compartment lymph node, neck lymph node dissection