Objective To explore the improvement of modified radical neck dissection in clinical node positive(cN +) low risk papillary thyroid cancer patients.Methods Seventy-one cases of papillary thyroid cancer with cN+ underwent selective neck dissection (Ⅱ a,Ⅲ,Ⅳ) from 2007 to 2010 were reviewed,including 10 men and 61 women.All patients were at stage Ⅰ,including 15 T1,46 T2,10 T3.Twenty-six patients were found Positive nodes were found by palpation in 26 cases and by ultrasonagraphy in 45 cases.Results Cervical lymph node metastasis were confirmed pathologically in 63 cases,with metastatic rate of 88.7％;100％ in cN + cases by palpation and 82.2％ in cN + cases by ultrasonagraphy,respectively.Metastatic nodes existed in one level in 13 cases,two levels in 31 cases,and three levels in 19cases.Recurrence occurred to 4 patients during follow up,with a recurrent rate of 5.6％,and 2 cases of them were found recurrence in the anterior part of Ⅴ b,2 cases in the carotid sheath.Conclusion Selective neck dissection (Ⅱ a,Ⅲ,Ⅳ) is acceptable for cN + low risk papillary thyroid cancer patients,which can decrease complications in neck and shoulder greatly.%目的 探讨临床淋巴结阳性(clinical node positive,cN+)的低危甲状腺乳头状癌患者传统改良性颈清扫术的改进方法.方法 回顾性分析2007-2010年期间收治的71例cN+低危甲状腺乳头状癌患者临床资料,其中男10例,女61例.T1 15例,T2 46例,T3 10例；均为临床Ⅰ期病例.其中26例患者触诊发现肿大淋巴结,45例患者触诊未发现而由超声检查发现肿大淋巴结.手术清扫淋巴结范围为Ⅱa、Ⅲ、Ⅳ区.结果 71例患者术后63例病理证实淋巴转移,转移率为88.7％,其中触诊发现肿大淋巴结的26例患者术后病理均发现转移淋巴结,转移率为100％；触诊未发现超声检查发现肿大淋巴结的45例患者术后病理证实37例有淋巴转移,转移率为82.2％.13例患者转移淋巴结累及1个淋巴结分区,31例累及2个分区,19例累及3个分区.患者随访24 ～ 60个月,中位随访时间42个月.术后颈部复发4例,复发率5.6％,2例Ⅴb区前份复发,2例颈动脉鞘区复发.结论 对于cN+低危甲状腺乳头状癌患者行Ⅱa、Ⅲ、Ⅳ区清扫是可接受的,可降低颈肩部并发症的发生率.
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