目的 探讨临床颈淋巴结阴性(cN0)伴高危因素甲状腺乳头状癌(papillary thyroid cancer,PTC)的颈淋巴结转移规律,并对其行选择性清扫的必要性.方法 回顾性分析87例临床颈淋巴结阴性伴高危因素甲状腺乳头状癌初次行甲状腺癌手术并同期行颈清扫术患者的临床资料,对结果进行统计学分析.结果 87例(89侧)患者中,颈淋巴结阳性率62.9％,其中中央组淋巴结(Ⅵ区)转移率58.4％,颈侧区(Ⅱ一Ⅳ)阳性率38.2％,Ⅵ区与颈侧区淋巴结阳性率比较,差异有统计学意义(配对x2检验,x2=11.12,P＜0.01),同时行关联性分析表明,VI区与颈侧区转移有相关性(x2=20.11,P＜0.05,Pearson列联系数C=0.43).Ⅵ区阳性者,Ⅱ、Ⅲ、Ⅳ区淋巴结转移率分别为30.8％、61.5％、42.3％,颈侧各区之间转移率差异有统计学意义(x2=10.30,P＜0.01).结论 cN0伴高危因素PTC患者,Ⅵ区与颈侧区淋巴结转移有相关性,且Ⅵ区阳性者,颈侧各区之间转移率有差异,建议此类患者在常规清扫VI区淋巴结基础上进一步行颈侧清扫术,并可根据肿瘤位于甲状腺不同部位,选择颈侧各区的清扫范围.%Objective To study the patterns of cervical lymph node metastases in cases of cNO papillary thyroid cancer with high risk factor and analyze the necessity of selective neck dissection. Methods Clinical data of 87 cNO papillary thyroid cancer patients with high risk factor underwent thyroidectomy with lateral neck dissection were retrospectively reviewed. Results The rate of cervical lymph node metastasis was 62.9% in 56 sizes of 89 cases. The positive rates of lymph node were 58.4% in level Ⅳ and 38.2% in level Ⅱ -Ⅳ, which were statistically different (x2=11.12, P<0.01). Relevance analysis indicated that lymph node metastasis in level Ⅳ and Ⅱ -Ⅳ was correlative (x2=20.11, P<0.05, Pearson course = 0.43). Among the patients of positive lymph node in level Ⅵ, the rates of cervical lymph node metastasis were 30.8%,61.5% and 42.3% in level Ⅱ -Ⅳ.which were statistically different (x2=10.30,P<0.01). Conclusions There were close relationship in the lymph node metastasis between level Ⅵ and lateral area in cNO papillary thyroid cancer patients with high risk factor. This suggests that it is necessary to dissect lymph nodes of lateral area in cNO papillary thyroid cancer patients with high risk factor when lymph nodes in level Ⅵ were positive, and the dissection scope of lateral area is determined by tumor position of thyroid.
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