Abstract:

Several issues concerning lateralcervicallymph nodes dissection for differentiated thyroid carcinoma        XU Zhen-gang, LIU Shao-yan, ZHU Yi-ming. Department of Head and Neck Surgery,  Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center,Beijing 100021,China
Corresponding author：XU Zhen-gang,E-mail：xuzhg02@126.com
Abstract    Papillary thyroid carcinoma (PTC) constitutes the major part of differentiated thyroid carcinoma (DTC). Cervical lymph nodes metastasis is common for PTC. It is essential to treat cervical lymph nodes metastasis rationally and radically. Cervical lymph nodes dissection is currently the best treatment for DTC with cervical lymph modes metastasis. Preoperative evaluation for cervical lymph nodes metastasis should include neck ultrasonography and enhanced computed tomography (CT). Thin slice CT scanning including neck and the thorax is recommended. Enhanced magnetic resonance imaging can substitute CT in case of iodine contrast agent allergy. Indication for lateral cervical lymph nodes dissection is cytology or pathology confirmed lymph nodes metastasis in the lateral neck. Prophylactic lateral cervical lymph nodes dissection is not recommended. The extent of lateral cervical lymph nodes dissection should include levels Ⅱ（Ⅱa）,Ⅲ,Ⅳ, andⅤb. Minimal acceptable extent includes levels Ⅱ(Ⅱa),Ⅲ, and Ⅳ. When applying the minimal acceptable extent, the indications for dissection of levels Ⅱb and Ⅴ should be assessed carefully. Based on the radical excision of the disease, more attention should be paid to the protection of nerves and vessels over the dissected region for the improvement of quality of life.

Key words: differentiated thyroid carcinoma, papillary thyroid carcinoma, cervical lymph nodes metastasis, cervical lymph nodes dissection

摘要：

分化型甲状腺癌（DTC）中甲状腺乳头状癌（PTC）占绝大部分。PTC的重要特点是易出现颈部淋巴结转移。合理、彻底处理颈部淋巴结转移癌是治疗DTC的重要环节，目前的最佳治疗手段是颈淋巴结清扫术。颈侧区淋巴结转移的术前评估推荐颈部超声结合颈胸部增强CT。CT以薄层扫描为佳。对于碘造影剂过敏病人推荐颈部增强MRI检查。颈侧区淋巴结清扫（以下简称侧颈清扫）的适应证是细胞学或病理学检查确诊的颈侧区淋巴结转移，不推荐行预防性侧颈清扫。侧颈清扫的范围应包括Ⅱ（Ⅱa）、Ⅲ、Ⅳ、Ⅴb区。Ⅱ（Ⅱa）、Ⅲ、Ⅳ区是可接受的最小颈侧区淋巴结清扫范围。应用最小颈侧区淋巴结清扫范围时，应特别注意Ⅱb区和Ⅴ区清扫的适应证。在彻底手术切除基础上，应重视对于神经和血管的保护，以提高病人生活质量。

关键词: 分化型甲状腺癌, 甲状腺乳头状癌, 颈淋巴结转移癌, 颈淋巴清扫术