颈侧区探查联合中央区清扫在甲状腺乳头状癌手术中的应用

摘要

Objective To discuss the application value of lateral cervical exploration combined with central lymph node dissection in papillary thyroid carcinoma.Methods Clinical data of 69 cases(86 sides) with papillary thyroid carcinoma in our hospital from Jan 2001 to Jun 2011 were collected.These cases were treated with lateral cervical exploration combined with central lymph node dissection,they were divided into lateral cervical cN+ and cN0 group to analyze lymph node metastasis and related factors,intraoperative frozen accuracy and postoperative complications.Results The metastasis rates of lateral cervical and central area were all higher in oN+ group than these in cN0 group.In cN0 group the metastasis rate of lateral cervical was higher in T2-T4 than that in T1.To compare with the results of paraffin section,the accordant rate of frozen pathology was 95 ％ (38/40) in cN+ group,the diagnostic accordance rate was 93.5 ％ (43/46) by intraoperative frozen section in cN0 group.Hoarseness occurred in none patient in primary surgery and 3 in second operation.4 patients had low calcium in primary surgery,while 10 patients in second operation,the difference had statistical significance(P=0.008).Conclusion Lateral cervical exploration is not recommended to T1 cN0 papillary thyroid carcinoma.Lateral cervical exploration combined with central lymph node dissection is recommended for the cN+ patients and cN0 patients with T2-T4.Frozen pathology during operation can direct operation.Postoperative complications increases in second operation.%目的 探讨颈侧区探查联合中央区淋巴结清扫在甲状腺乳头状癌患者手术中的应用价值.方法 收集河北医科大学第四医院2006年1月至2011年7月行颈侧区探查联合同侧中央区淋巴结清扫69例(共计86侧)甲状腺乳头状癌临床资料,分为颈侧区cN+组和颈侧区cN0组,对此术式涉及区域的淋巴结转移情况及相关因素、术中冰冻准确性、术后并发症进行分析.结果 颈侧区cN+组颈侧区转移率(90％)和中央区转移率(85％)均高于颈侧区cN0组颈侧区转移率(13％)(x2=50.711,P＜0.05)和中央区转移率(26％)(x2=29.848,P＜0.05).颈侧区cN0组原发灶T1以上者较T1者颈侧区转移率高(P=0.005).颈侧区cN+组颈侧淋巴结术中冰冻与术后病理检查符合率为95％(38/40),颈侧区cN0组符合率为93.5％(43/46).初次手术声嘶0例,二次手术声嘶3例(P=0.123).初次手术出现4例低钙,低于二次手术的10例(P=0.008).结论 颈侧区cN0且原发灶为T1的甲状腺乳头状癌可不行颈侧区探查.颈侧区cN+以及T1以上颈侧区cN0甲状腺乳头状癌建议行颈侧区探查联合同侧中央区清扫术,术中送冰冻,根据冰冻病理检查进一步指导手术.二次手术并发症增加.