甲狀腺微小乳頭狀癌頸淋巴結清掃的臨床研究_《中國普外基礎與臨床雜志》

作者：

張建明 , 蘇艷軍 , 刁暢 , 程若川

昆明醫學院第一附屬醫院胃腸與甲狀腺外科,云南省甲狀腺外科臨床研究中心(云南昆明 650032);

關鍵詞：

甲狀腺微小乳頭狀癌淋巴結轉移頸淋巴結清掃高分辨率超聲診斷

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目的探討甲狀腺微小乳頭狀癌頸淋巴結轉移的危險因素，分析高分辨率B超對頸側區淋巴結轉移的診斷價值和淋巴結清掃的安全性。方法回顧性分析2004年1月至2010年6月期間我院連續收治的284例甲狀腺微小乳頭狀癌患者的臨床資料。結果頸淋巴結轉移率為29.2%(83/284),中央組淋巴結轉移率為22.2%(63/284),同時發生中央組和頸側區淋巴結轉移率為4.9%(14/284),跳躍式(僅頸側區)淋巴結轉移率為2.1%(6/284)。年齡 lt;45歲、腫瘤直徑≥5 mm、多灶性和甲狀腺外浸潤者頸淋巴結轉移率明顯升高(P lt;0.05)。未發現跳躍式淋巴結轉移的危險因素。行中央組+頸側區淋巴結清掃患者的術后住院時間長于未行淋巴結清掃患者和行中央組淋巴結清掃者(P lt;0.05)，3種手術后甲狀旁腺和喉返神經損傷均為暫時性，損傷率差異均無統計學意義(P gt;0.05)。高分辨率B超對跳躍式淋巴結轉移診斷的靈敏度、特異度、假陰性率和假陽性率分別為95.0%、75.0%、5.0%和25.0%，陽性和陰性預測值分別為90.5%和85.7%。結論對有頸淋巴結轉移危險因素(年齡 lt;45歲、腫瘤直徑≥5 mm、多灶性、甲狀腺外浸潤)的患者建議行甲狀腺全切除，同時行中央組淋巴結清掃，是安全的; 高分辨率B超可作為頸側區淋巴結轉移的重要評估手段; 對高度懷疑跳躍式淋巴結轉移者應行功能性頸淋巴結清掃。

引用本文： 張建明,蘇艷軍,刁暢,程若川. 甲狀腺微小乳頭狀癌頸淋巴結清掃的臨床研究. 中國普外基礎與臨床雜志, 2011, 18(4): 414-418. doi: 復制

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4.	徐曉波, 劉文勇. 結節性甲狀腺腫合并甲狀腺微小癌42例分析 [J]. 中國普外基礎與臨床雜志, 2011, 18(2): 196197.
5.	Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
6.	Zafon C, Baena JA, Castellví J, et al. Differences in the form of presentation between papillary microcarcinomas and papillary carcinomas of larger size [J]. J Thyroid Res, 2010, 2011: 639156.
7.	Lim YC, Choi EC, Yoon YH, et al. Central lymph node metastases in unilateral papillary thyroid microcarcinoma [J]. Br J Surg, 2009, 96(3): 253257.
8.	Chung YS, Kim JY, Bae JS, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection [J]. Thyroid, 2009, 19(3): 241246.
9.	Choi SJ, Kim TY, Lee JC, et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? [J]. Clin Exp Otorhinolaryngol, 2008, 1(1): 4145.
10.	Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis [J]. Ann Surg Oncol, 2008, 15(9): 24822486.
11.	Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone [J]. Ann Surg, 2007, 245(4): 604610.
12.	Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment [J]. Arch Surg, 2004, 139(1): 4345.
13.	Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection [J]. Ann Surg Oncol, 2008, 15(4): 11771182.
14.	Coatesworth AP, MacLennan K. Cervical metastasis in papillary carcinoma of the thyroid: a histopathological study [J]. Int J Clin Pract, 2002, 56(4): 241242.
15.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection [J]. Ann Surg, 2003, 237(3): 399407.
16.	Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality [J]. Cancer, 2003, 98(1): 3140.
17.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid [J]. World J Surg, 2006, 30(1): 9199.
18.	Kim TY, Hong SJ, Kim JM, et al. Prognostic parameters for recurrence of papillary thyroid microcarcinoma [J]. BMC Cancer, 2008, 8: 296.
19.	Ali S, Tiwari RM, Snow GB. Falsepositive and falsenegative neck nodes [J]. Head Neck Surg, 1985, 8(2): 7882.
20.	Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer [J]. Arch Surg, 2006, 141(5): 489494.
21.	Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer [J]. Laryngoscope, 2011, 121(3): 487491.
22.	Kim E, Park JS, Son KR, et al. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography [J]. Thyroid, 2008, 18(4): 411418.
23.	Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection papillary thyroid carcinoma [J]. Surgery, 2005, 138(6): 10951100.
24.	程若川, 蘇艷軍, 張建明, 等. 甲狀腺手術方式和喉返神經顯露與神經損傷的關系 [J]. 中國普通外科雜志, 2007, 16(1): 1517.
25.	Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients [J]. Thyroid, 2009, 19(7): 707716.
26.	程若川, 艾楊卿, 刁暢, 等. 甲狀腺手術中甲狀旁腺顯露及功能保護的臨床研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(5): 351355.
27.	程若川, 蘇艷軍, 刁暢, 等. 高分化甲狀腺癌再手術原因和頸淋巴結轉移的危險因素分析 [J]. 國際外科學雜志, 2010, 37(2): 9598.

1. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study [J]. Cancer, 1985, 56(3): 531538.
2. Lin JD, Kuo SF, Chao TC, et al. Incidental and nonincidental papillary thyroid microcarcinoma [J]. Ann Surg Oncol, 2008, 15(8): 22872292.
3. Grodski S, Delbridge L. An update on papillary microcarcinoma [J]. Curr Opin Oncol, 2009, 21(1): 14.
4. 徐曉波, 劉文勇. 結節性甲狀腺腫合并甲狀腺微小癌42例分析 [J]. 中國普外基礎與臨床雜志, 2011, 18(2): 196197.
5. Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
6. Zafon C, Baena JA, Castellví J, et al. Differences in the form of presentation between papillary microcarcinomas and papillary carcinomas of larger size [J]. J Thyroid Res, 2010, 2011: 639156.
7. Lim YC, Choi EC, Yoon YH, et al. Central lymph node metastases in unilateral papillary thyroid microcarcinoma [J]. Br J Surg, 2009, 96(3): 253257.
8. Chung YS, Kim JY, Bae JS, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection [J]. Thyroid, 2009, 19(3): 241246.
9. Choi SJ, Kim TY, Lee JC, et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? [J]. Clin Exp Otorhinolaryngol, 2008, 1(1): 4145.
10. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis [J]. Ann Surg Oncol, 2008, 15(9): 24822486.
11. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone [J]. Ann Surg, 2007, 245(4): 604610.
12. Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment [J]. Arch Surg, 2004, 139(1): 4345.
13. Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection [J]. Ann Surg Oncol, 2008, 15(4): 11771182.
14. Coatesworth AP, MacLennan K. Cervical metastasis in papillary carcinoma of the thyroid: a histopathological study [J]. Int J Clin Pract, 2002, 56(4): 241242.
15. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection [J]. Ann Surg, 2003, 237(3): 399407.
16. Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality [J]. Cancer, 2003, 98(1): 3140.
17. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid [J]. World J Surg, 2006, 30(1): 9199.
18. Kim TY, Hong SJ, Kim JM, et al. Prognostic parameters for recurrence of papillary thyroid microcarcinoma [J]. BMC Cancer, 2008, 8: 296.
19. Ali S, Tiwari RM, Snow GB. Falsepositive and falsenegative neck nodes [J]. Head Neck Surg, 1985, 8(2): 7882.
20. Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer [J]. Arch Surg, 2006, 141(5): 489494.
21. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer [J]. Laryngoscope, 2011, 121(3): 487491.
22. Kim E, Park JS, Son KR, et al. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography [J]. Thyroid, 2008, 18(4): 411418.
23. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection papillary thyroid carcinoma [J]. Surgery, 2005, 138(6): 10951100.
24. 程若川, 蘇艷軍, 張建明, 等. 甲狀腺手術方式和喉返神經顯露與神經損傷的關系 [J]. 中國普通外科雜志, 2007, 16(1): 1517.
25. Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients [J]. Thyroid, 2009, 19(7): 707716.
26. 程若川, 艾楊卿, 刁暢, 等. 甲狀腺手術中甲狀旁腺顯露及功能保護的臨床研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(5): 351355.
27. 程若川, 蘇艷軍, 刁暢, 等. 高分化甲狀腺癌再手術原因和頸淋巴結轉移的危險因素分析 [J]. 國際外科學雜志, 2010, 37(2): 9598.

《中國普外基礎與臨床雜志》

甲狀腺微小乳頭狀癌頸淋巴結清掃的臨床研究

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《中國普外基礎與臨床雜志》

甲狀腺微小乳頭狀癌頸淋巴結清掃的臨床研究

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