摘要
目的 分析甲状腺乳头状癌颈部淋巴结复发病例中各个区域淋巴结复发率,再次术后疗效及并发症发生情况.方法 回顾性分析2010年1月1日至2011年6月1日,中国医学科学院肿瘤医院头颈外科259例复发性甲状腺乳头状癌行区域淋巴清扫患者的病历资料,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甲状腺球蛋白值预测疗效.连续变量使用t检验比较,分类变量则采用Fisher精确概率法检验.结果 259例患者出现淋巴结转移,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％.根据副神经将44例患者的Ⅱ区分成Ⅱa、Ⅱb,转移率分别为52.3％、18.2％ （P =0.887）.单侧颈侧转移较双侧更多见（73.1％比20.6％,P＜0.001）,颈侧相较于中央区可能更容易发生转移（80.7％比59.1％,P＜0.001）.术后47例（18.1％）出现术后并发症,其中永久性低钙10例.结论 甲状腺癌颈部复发转移再次手术建议一般清扫Ⅱ-Ⅳ和Ⅵ区.复发手术术后并发症发生率较高,建议由经验丰富的医师处理.
Objective To analyse the postoperative metastasis or recurrence of cervical lymph nodes in individual neck levels for papillary thyroid carcinoma and to evaluate the outcomes and complications of resurgery.Methods A retrospective cohort study of 259 patients who underwent lymph node dissection for PTC relapse from January 2010 to June 2011.Lymph node metastases in each of neck levels were detected,postoperative complications were evaluated,and the patients were followed up with examining thyroglobulin levels to assess the therapeutic effect.Continuous variables were compared with t test.Categorical variables were compared with Fisher＆#39;s exact test.Results Lymph node metastasis was found in 259 cases and lymph node metastasis rates in levels Ⅱ,Ⅲ,Ⅳ,Ⅴ and Ⅵ were 43.2%,50.2%,45.6%,8.1% and 59.1% respectively.In 44 cases received the neck dissection of level Ⅱ,the metastasis rates in the levels Ⅱ a and Ⅱ b were respectively （52.3% vs 18.2%,P =0.887）.Recurrence in unilateral lateral neck was more common than that in bilateral lateral neck （73.1% vs 20.6%,P 〈0.001）.The lymph nodes in lateral neck were more likely to metastasize than those in central region （80.7% vs 59.1%,P 〈 0.001）.There were 47 cases （18.1%） had postoperative complications,including 10 cases with permanent hypocalcemia.Conclusions The scope of re-operation for neck metastasis or recurrence in papillary thyroid carcinoma should include the dissection of levels Ⅱ-Ⅳ and Ⅵ.The incidence of postoperative complications for re-surgery is high,and re-surgery should be performed by experienced surgeon.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2017年第6期416-420,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
甲状腺肿瘤
癌
乳头状
复发
淋巴转移
Thyroid neoplasms
Carcinoma,papillary
Recurrence
Lymphatic metastasis
