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目的 :对首次甲状腺乳头状癌手术未清扫中央区淋巴结,术后颈侧区淋巴结复发转移,再行颈侧区淋巴结清扫术时,是否需清扫中央区淋巴结进行探讨。方法:回顾性分析2003年1月至2014年12月在八五医院和瑞金医院外科手术治疗的44例甲状腺乳头状癌病人资料。结果:首次手术44例中12例甲状腺癌肿位于甲状腺上极病人,再次手术发现颈侧区淋巴结有转移而中央区淋巴结无转移;余32例癌肿位于甲状腺中下极或下极,再次手术发现颈侧区和中央区淋巴结均有转移。术后有5例(11.36%,5/44)出现暂时性声音嘶哑,7例(15.91%,7/44)出现暂时性低钙血症。结论:对首次手术未行中央区淋巴结清扫而甲状腺癌肿位于中下极或下极的病人,再次手术行颈侧区淋巴结清扫时,需清扫中央区淋巴结;但探查中央区无异常肿大淋巴结,可不清扫。对癌肿位于甲状腺上极的病人,为降低手术风险也可不清扫中央区淋巴结。
OBJECTIVE: To explore whether the central lymph nodes need to be dissected during the first operation of papillary thyroid carcinoma without clearing the central lymph nodes, the recurrence and metastasis of the lateral cervical lymph nodes, and then the neck lateral lymph node dissection. Methods: A retrospective analysis of 44 patients with thyroid papillary carcinoma treated surgically at the 85 Hospital and Ruijin Hospital from January 2003 to December 2014 was performed. Results: Of the 44 cases of the first operation, 12 cases of thyroid cancer were located in the patients with thyroid glandular pole disease. There was no lymph node metastasis in the cervical region after reoperation. The remaining 32 cases were located in the middle or lower pole of the thyroid gland. Found in the lateral neck and central lymph node metastasis. Five patients (11.36%, 5/44) had transient hoarseness after operation, and 7 cases (15.91%, 7/44) had transient hypocalcemia. Conclusions: In the first operation, the central lymph node dissection is not performed and the thyroid cancer is located in the middle and lower pole or lower pole. , Can not clean. The cancer is located in the thyroid pole in patients with surgery to reduce the risk may not clear the central lymph nodes.