【摘要】：目的:對(duì)甲狀腺乳頭狀癌頸部淋巴復(fù)發(fā)的總體人群分析各個(gè)區(qū)域淋巴結(jié)復(fù)發(fā)率,再次術(shù)后療效及并發(fā)癥發(fā)生情況。對(duì)既往手術(shù)區(qū)域再次出現(xiàn)復(fù)發(fā)的人群研究二次頸側(cè)清掃已手術(shù)區(qū)域淋巴復(fù)發(fā)及轉(zhuǎn)移規(guī)律。方法:回顧性分析2010-01至2011-06我院復(fù)發(fā)性甲狀腺乳頭狀癌行頸部淋巴結(jié)清掃共259例,統(tǒng)計(jì)各區(qū)域淋巴結(jié)轉(zhuǎn)移分布規(guī)律,并統(tǒng)計(jì)術(shù)后并發(fā)癥發(fā)生率和術(shù)后隨訪監(jiān)測(cè)Tg值預(yù)測(cè)療效。收集分析2000-01至2016-12二次頸側(cè)淋巴清掃甲狀腺乳頭狀癌336例,共360側(cè)清掃,以二次手術(shù)時(shí)間是否超過(guò)6個(gè)月分為2組,分析Ⅱ、Ⅲ、Ⅳ、Ⅴ區(qū)域淋巴結(jié)轉(zhuǎn)移率、陽(yáng)性淋巴結(jié)數(shù)及清掃淋巴結(jié)總數(shù)。結(jié)果:側(cè)頸復(fù)發(fā)總體人群研究發(fā)現(xiàn)Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ區(qū)淋巴結(jié)轉(zhuǎn)移率分別為43.2%、50.2%、45.6%、8.1%、59.1%。44例病例根據(jù)副神經(jīng)將Ⅱ區(qū)分成ⅡA、ⅡB,轉(zhuǎn)移率分別為52.27%、18.18%(P=0.887)。單側(cè)側(cè)頸較雙側(cè)側(cè)頸更多見(jiàn)(73.1%VS 20.6%,P0.001),側(cè)頸相較于中央?yún)^(qū)可能更容易發(fā)生轉(zhuǎn)移(80.7%VS 59.1%,P0.001)。術(shù)后47例(18.1%)出現(xiàn)術(shù)后并發(fā)癥,其中永久性低鈣10例。復(fù)發(fā)行二次清掃的人群發(fā)現(xiàn)單側(cè)側(cè)頸淋巴轉(zhuǎn)移率92.9%(312/336),兩個(gè)及以上區(qū)域轉(zhuǎn)移率47.5%(171/360)。Ⅱ、Ⅲ、Ⅳ、Ⅴ區(qū)轉(zhuǎn)移率分別為 55.6%(200/360)、44.2%(156/360)、59.7%(215/360)、10.3%(37/360)。陽(yáng)性淋巴結(jié)主要位于Ⅱ區(qū)(33.6%)和Ⅳ區(qū)(35.8%)。二次手術(shù)間隔≤6個(gè)月較6個(gè)月組,陽(yáng)性淋巴結(jié)枚數(shù)(4.37枚/例比3.2枚/例,P=0.001)和清掃淋巴結(jié)總枚數(shù)(26.56枚/例比16.8枚/例,P0.001)較多。結(jié)論:甲狀腺癌頸部復(fù)發(fā)轉(zhuǎn)移再次手術(shù)建議常規(guī)清掃Ⅱ-Ⅳ和Ⅵ區(qū)。復(fù)發(fā)手術(shù)術(shù)后并發(fā)癥發(fā)生率較高,建議由經(jīng)驗(yàn)豐富醫(yī)師處理。二次頸側(cè)淋巴清掃以Ⅱ、Ⅳ區(qū)淋巴轉(zhuǎn)移(殘留)多見(jiàn),其中多區(qū)轉(zhuǎn)移并不少見(jiàn),這些區(qū)域首次清掃時(shí)尤需重視。其中大部分患者為首次手術(shù)后淋巴殘留,為減少淋巴殘留,實(shí)施規(guī)范的頸淋巴清掃術(shù)尤為重要。
[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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R736.1

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1 劉杰;唐平章;徐震綱;;甲狀腺乳頭狀癌頸后三角淋巴結(jié)隱匿轉(zhuǎn)移的臨床分析[J];中華腫瘤雜志;2010年04期

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本文編號(hào)：2243614