目的 研究甲状腺乳头状癌cN0期患者中央区淋巴结转移规律.方法 回顾性分析我院2009年2月至2015年12月行全甲状腺切除±双侧中央区淋巴结清扫术的245例单侧甲状腺乳头状癌cN0期患者的临床病理资料.结果 甲状腺乳头状癌cN0患者中央区淋巴结转移率36.8％(91/245),中央区淋巴结转移与患者性别(x2=5.626,P=0.018)、年龄(x2=6.255,P=0.012)、肿瘤直径(x2=20.063,P＜0.001)、肿瘤侵犯甲状腺被膜(x2=15.024,P＜0.001)相关.其中,直径＞1 cm的116例甲状腺乳头状癌患者中央区淋巴结转移率51.7％ (60/116),对侧中央区淋巴结转移率22.4％ (26/116),对侧中央区淋巴结转移与肿瘤侵犯甲状腺被膜(x2=9.737,P=0.002)、喉前淋巴结转移(x2=10.982,P=0.001)相关.245例患者中术后发生暂时性单侧喉返神经损伤6例(2.4％),暂时性甲状旁腺功能减退96例(39.2％),无永久性喉返神经损伤,永久性甲状旁腺功能减退3例(1.2％).中位随访时间40个月,6例出现同侧颈部区域淋巴结复发,Kaplan-Meier曲线显示肿瘤直径＞1 cm患者组复发率高于肿瘤直径≤1 cm组(P =0.008),中央区淋巴结有转移患者组复发率高于无转移组(P =0.001).结论 甲状腺乳头状癌cN0期患者中央区淋巴结转移率较高,中央区淋巴结转移增加复发风险,肿瘤直径＞1 cm者建议行预防性双侧中央区淋巴结清扫.%Objective To explore central lymph node metastasis (CLNM) of cN0 papillary thyroid carcinoma(PTC).Methods We evaluate the clinical data of 245 patients with cN0 unilateral TPC undergoing total thyroidectomy and bilateral central lymph node dissection.Results Central lymph node metastasis of cN0 TPC was 36.8％ (91/245),significantly related to gender(x2 =5.626,P =0.018),age (x2 =6.255,P =0.012),tumor size (x2 =20.063,P ＜ 0.001) and capsule invasion (x2 =15.024,P ＜ 0.001).The central lymph node metastasis was 51.7％ (60/116) in 116 patients with tumor size ＞ 1 cm,and the contralateral CLNM was 22.4％ (26/116) which was related to capsule invasion (x2 =9.737,P =0.002) and delphian LNM(x2 =10.982,P =0.001) There were 6 cases (2.4％) suffering from temporary unilateral recurrent laryngeal nerve injury.96 cases (39.2％) suffered from temporary hypoparathyroidism and 3 cases (1.2％) from permanent hypoparathyroidism.The median follow-up time was 40 months.6 cases were found regional lymph node recurrence on the ipsilateral side.Tumor size ＞ 1 cm was significantly related with recurrence (P =0.008),as CLNM with higher recurrence rate (P =0.001).Conclusions CLNM is common in cN0 PTC patients,and central lymph node metastases increase the risk of recurrence.Prophylactic bilateral central lymph node dissection is suggested for tumor size ＞ 1 cm cases.
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