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目的探讨右侧及双侧cN0甲状腺乳头状癌(cN0 PTC)患者喉返神经腹侧和背侧淋巴结清扫范围,为完善其临床手术策略提供依据。方法回顾性分析浙江省宁波市第二人民医院收治的186例右侧和双侧cN0 PTC患者,均行甲状腺摘除加中央区淋巴结清扫。淋巴结送病理科检查,统计阳性率。对于喉返神经背侧淋巴结阳性者,分析其病理资料与其他患者的差异。用SPSS 19.0软件包进行统计学分析,计数资料的比较用χ~2检验,危险因素采用多因素非条件logistic回归分析。结果 186例患者中Ⅵ区淋巴结转移率为44.6%(83/186),共检出231枚阳性淋巴结,依次位于喉返神经腹侧(43.7%)、喉返神经背侧(28.6%)、喉前(15.2%)和气管前(12.6%)。单因素分析结果显示,年龄、病灶大小、类型、包膜侵犯、病灶数目及T分期均能影响喉返神经背侧淋巴结转移率,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,病灶>1.5 cm、包膜侵犯、病灶数目为多个及T_4均为喉返神经背侧淋巴结转移的危险因素(P<0.05)。结论 cN0 PTC患者手术中建议喉返神经腹侧区域常规清扫淋巴结,对于有淋巴结转移危险因素的患者,喉返神经背侧区域也应做预防性清扫。
Objective To investigate the range of lymph node dissection in the right and left cN0 thyroid papillary carcinoma (cN0 PTC) in patients with recurrent laryngeal nerve to provide the basis for improving its clinical surgical strategy. Methods A retrospective analysis of 186 cases of right and bilateral cN0 PTC patients admitted to Second People’s Hospital of Ningbo City in Zhejiang Province was performed with thyroid removal plus central lymph node dissection. Lymph nodes to send pathology examination, statistics positive rate. For the recurrent laryngeal lymph nodes of the recurrent laryngeal nerve, the difference between the pathological data and other patients was analyzed. SPSS 19.0 software package for statistical analysis, count data were compared using χ ~ 2 test, risk factors using multivariate non-conditional logistic regression analysis. Results The lymph node metastasis rate in Ⅵ of the 186 patients was 44.6% (83/186). A total of 231 positive lymph nodes were found, which located in the ventral rectus nerve (43.7%), dorsal to the recurrent laryngeal nerve (28.6%), throat Before (15.2%) and before tracheal (12.6%). Univariate analysis showed that age, lesion size, type, invasion of envelope, number of lesions and T stage all affected the rate of lymph node metastasis of recurrent laryngeal nerve, with statistical significance (P <0.05). The results of logistic regression analysis showed that the lesions were> 1.5 cm, the invasion of the capsule, the number of the lesions and the number of T 4 were all the risk factors of dorsal lymphnode metastasis (P <0.05). CONCLUSIONS: Conventional lymph node dissection in the ventral region of the recurrent laryngeal nerve is recommended in patients with cN0 PTC. For patients with risk factors for lymph node metastasis, the dorsal reflex nerve should also be preventively dissected.