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1、第17卷第11期中国普通外科杂志Vol.17No.112008年11月ChineseJournalofGeneralSurgeryNov.2008文章编号:1005-6947(2008)11-1051-03·甲状腺外科专题研究·乳头状甲状腺癌的颈部淋巴结转移规律与手术方式李治,刘春萍,屈新才,黄韬(华中科技大学附属协和医院乳腺甲状腺外科,湖北武汉430022)摘要:目的探讨甲状腺乳头状癌颈部淋巴结的转移规律以及清扫范围的合理选择。方法回顾性分析近4年多来收治的457例乳头状甲状腺癌患者的临床资料。结果全组患者均接受常
2、规甲状腺双侧全切加颈深(Ⅲ+Ⅳ区)组及中央(Ⅵ区)组颈部淋巴结清扫术。颈部淋巴结总转移发生率为63.67%(291/457),中央组淋巴结转移发生率为59.08%(270/457),颈深组淋巴结转移发生率为29.76%(136/457)。当癌肿直径>1cm或癌肿突破甲状腺包膜、侵犯肌肉时各区淋巴结转移的发生率明显增加(P<0.05)。全组无手术或住院期间死亡。结论乳头状甲状腺癌最常见的淋巴结转移为中央组淋巴结,其次为颈深组(Ⅲ+Ⅳ区)的淋巴结,初次手术应常规清扫双侧中央组淋巴结,当肿块直径>1cm或癌肿突破甲状腺包膜
3、和/或侵犯肌肉时宜同时,清扫同侧的颈深组淋巴结。[中国普通外科杂志,2008,17(11):1051-1053]关键词:甲状腺肿瘤/外科学;癌,乳头状;淋巴结转移;颈淋巴结清扫术中图分类号:R736.1文献标识码:ATheregularityofcervicallymphnodemetastasisofpapillarythyroidcancerandselectionofsurgicalprocedureLIZhi,LIUChunping,QUXincai,HUANGTao(DepartmentofBreastan
4、dThyroidSurgery,UnionHospital,HuazhongUniversityofScienceandTechnology,Wuhan430022,China)Abstract:ObjectiveTostudytheregularityofcervicallymphmetastasisofpapillarythyroidcancerandselectareasonableextentoflymphnodedissection.MethodsClinicaldataof457papillarythyr
5、oidcancerpatientsatourhospitalbetweenJun,2003andSep,2007wereretrospectivelyreviewed.ResultsAllpatientsroutinelyunderwentbilateralthyroidectomyanddeepandcentralcervicallymphnodedissection(Ⅲ,Ⅳ+Ⅵregion).Thetotalrateofcervicallymphnodemetastasiswas63.67%(291/457),m
6、etastasesthatoccurredincentralregionanddeepjugularlymphnodeswas59.08%(270/457)and29.76%(136/457),respectively.Therateofcervicallymphnodemetastasiswasmarkedlyincreasedwithdiameterofprimaryneoplasm>1cmortumorpenetratingthroughthethyroidcapsule(P<0.05).Conclusions
7、Forpapillarythyroidcancer,themostcommoncervicallymphnodemetastasisisthecentralregion,thenthedeepjugular(Ⅲ+Ⅳregion)lymphnodes.Forprimaryoperation,itisnecessarytoroutinelydissectthebilateralcentrallymphnodes,anditisreasonabletodissecttheipsilateraldeepjugularlymp
8、hnodeswhendiameterofprimaryneoplasmis>1cmortumorpenetratethroughthethyroidcapsule.[ChineseJournalofGeneralSurgery,2008,17(11):1051-1053]Keywords:ThyroidNeoplasms/surg;Carcin
