颈淋巴结阴性甲状腺乳头状癌中央区淋巴结转移高危因素及预防性清扫的临床研究

摘要

目的 探讨颈淋巴结阴性(cN0)PTC中央区淋巴结转移的高危因素及预防性中央组淋巴结清扫治疗的临床价值和可行性.方法 系统回顾性分析大连医科大学附属第二医院2012年1月至2014年1月诊治的315例cN0 PTC患者的临床资料,探讨cN0PTC中央区淋巴结转移的高危因素,阐述行预防性中央区淋巴结清扫的临床意义.结果 ①肿瘤大小、被膜浸润、肿瘤数目3个指标对cN0PTC中央区淋巴结转移有影响,差异有统计学意义(P＜0.05),影响cN0 PTC中央区淋巴结转移的高危因素为被膜浸润及肿瘤多发(P＜0.05);②术后并发症总的发生率为3.17％(10/315),并发暂时性RLN麻痹发生率为0.63％(2/315),暂时性甲状旁腺功能减退发生率为2.54％(8/315),治疗后恢复正常;无永久性RLN及甲状旁腺损伤等永久性并发症发生;③随访时间6～30个月,2例失访,无患者发生肿瘤局部复发、远处转移及死亡.结论 cN0 PTC 中央区淋巴结转移的高危因素为被膜浸润及肿瘤多发;随访无复发、远处转移及死亡发生,故对以上患者行预防性中央组淋巴结清扫是有必要的.%Objective To investigate the risk factors of central lymph node metastasis and significance of prophylactic central lymph node dissection for clinical N0 (cN0) patients with papillary thyroid carcinoma (PTC).Methods The clinical data of 315 patients with cN0 PTC in Department of General surgery,the Second Affiliated Hospital of Dalian Medical University from Jan.2012 to Jan.2014 were analyzed retrospectively.Results (Iumor size,infiltration of thyroid capsule,and tumor number were associated with central lymph node metastasis in patients with cN0 PTC(P＜0.05),and the high risk factors of central lymph node metastasis were infiltration of thyroid capsule and multiple lesions (P＜0.05);()The overall complication rate was 3.17％ (10/315),the rate of transient recurrent laryngeal nerve paralysis was 0.63％ (2/315),and the rate of transient hypoparathyroidism was 2.54％ (8/315).All patients with complications recovered after treatment.No patient developed permanent recurrent laryngeal nerve paralysis or hypoparathyroidism;()The follow-up time was 6 to 30 months,and 2 cases were lost.No patient developed local tumor recurrence,distant metastasis,or death.Conclusions The high risk factors of central lymph node metastasis in patients with cN0 PTC were infiltration of thyroid capsule and multiple lesions.No patient developed local tumor recurrence,distant metastasis,or death.It is preferable and necessary to perform prophylactic central lymph node dissection in patients with cN0 PTC.