甲状腺乳头状癌侧颈淋巴复发临床分析

发布时间：2018-09-14 19:07

【摘要】：目的:对甲状腺乳头状癌颈部淋巴复发的总体人群分析各个区域淋巴结复发率,再次术后疗效及并发症发生情况。对既往手术区域再次出现复发的人群研究二次颈侧清扫已手术区域淋巴复发及转移规律。方法:回顾性分析2010-01至2011-06我院复发性甲状腺乳头状癌行颈部淋巴结清扫共259例,统计各区域淋巴结转移分布规律,并统计术后并发症发生率和术后随访监测Tg值预测疗效。收集分析2000-01至2016-12二次颈侧淋巴清扫甲状腺乳头状癌336例,共360侧清扫,以二次手术时间是否超过6个月分为2组,分析Ⅱ、Ⅲ、Ⅳ、Ⅴ区域淋巴结转移率、阳性淋巴结数及清扫淋巴结总数。结果:侧颈复发总体人群研究发现Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ区淋巴结转移率分别为43.2%、50.2%、45.6%、8.1%、59.1%。44例病例根据副神经将Ⅱ区分成ⅡA、ⅡB,转移率分别为52.27%、18.18%(P=0.887)。单侧侧颈较双侧侧颈更多见(73.1%VS 20.6%,P0.001),侧颈相较于中央区可能更容易发生转移(80.7%VS 59.1%,P0.001)。术后47例(18.1%)出现术后并发症,其中永久性低钙10例。复发行二次清扫的人群发现单侧侧颈淋巴转移率92.9%(312/336),两个及以上区域转移率47.5%(171/360)。Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移率分别为 55.6%(200/360)、44.2%(156/360)、59.7%(215/360)、10.3%(37/360)。阳性淋巴结主要位于Ⅱ区(33.6%)和Ⅳ区(35.8%)。二次手术间隔≤6个月较6个月组,阳性淋巴结枚数(4.37枚/例比3.2枚/例,P=0.001)和清扫淋巴结总枚数(26.56枚/例比16.8枚/例,P0.001)较多。结论:甲状腺癌颈部复发转移再次手术建议常规清扫Ⅱ-Ⅳ和Ⅵ区。复发手术术后并发症发生率较高,建议由经验丰富医师处理。二次颈侧淋巴清扫以Ⅱ、Ⅳ区淋巴转移(残留)多见,其中多区转移并不少见,这些区域首次清扫时尤需重视。其中大部分患者为首次手术后淋巴残留,为减少淋巴残留,实施规范的颈淋巴清扫术尤为重要。
[Abstract]:Objective: To analyze the recurrence rate of cervical lymph nodes, postoperative outcomes and complications in patients with papillary thyroid carcinoma (PTC).To study the recurrence and metastasis of cervical lymph nodes in patients who had recurrence in the previous operation area.Methods: Retrospective analysis was made between 2010-01 and 2011-06. A total of 259 patients with recurrent papillary thyroid carcinoma underwent cervical lymph node dissection. The distribution of lymph node metastasis was analyzed. The incidence of postoperative complications and the Tg value of follow-up monitoring were also analyzed to predict the therapeutic effect. Results: The total number of positive lymph nodes and the total number of dissected lymph nodes in the patients with lateral neck recurrence was 43.2%, 50.2%, 45.6%, 8.1% and 59.1% respectively. Unilateral cervical metastasis was more common than bilateral cervical metastasis (73.1% VS 20.6%, P 0.001). Lateral cervical metastasis was more likely to occur than central cervical metastasis (80.7% VS 59.1%, P 0.001). Postoperative complications occurred in 47 cases (18.1%) including 10 cases of permanent hypocalcemia. The rate of metastasis was 92.9% (312/336), and the rate of metastasis in two or more regions was 47.5% (171/360). The rates of metastasis in regions II, III, IV and V were 55.6% (200/360), 44.2% (156/360), 59.7% (215/360) and 10.3% (37/360), respectively. Conclusion: Routine dissection is recommended for cervical recurrence and metastasis of thyroid cancer. The incidence of postoperative complications is high, and it is recommended that experienced physicians deal with it. Residual lymph nodes are common, and multizone metastasis is not uncommon, especially when first dissected. Most patients have residual lymph nodes after the first operation. Normal neck dissection is particularly important to reduce residual lymph nodes.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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