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目的探讨分化型甲状腺癌Ⅵ区与颈侧区(Ⅱ-Ⅴ)区颈淋巴转移的特点,为临床选择正确术式提供依据。方法回顾性分析1984年3月至2000年12月,99例甲状腺癌患者在辽宁省肿瘤医院头颈外科进行初次手术,同期行颈清扫术,进行病理检查,术后随访,并对结果进行统计分析。结果 99例分化型甲状腺癌中,乳头状甲状腺癌61例(双侧乳头状甲状腺癌1例),乳头滤泡混合型13例,滤泡状甲状腺癌25例。根据2002年 UICC TNM 分期:Ⅰ期60例,Ⅱ期1例,Ⅲ期5例,Ⅳ期33例。一侧腺叶及峡部切除80例,一侧腺叶及对侧大部或次全切除15例,全甲状腺切除术4例。全部患者同期颈清扫术104侧(双颈清扫5例),其中经典性清扫66例(68侧),改良性清扫33例(36侧)。术后病理检查淋巴结阳性83例(86侧),其中3例双侧淋巴结阳性,颈淋巴转移率为83.8%(83/99)。Ⅵ区阳性率37.5%(39/104),颈侧区(Ⅱ-Ⅴ区)阳性率76.9%(80/104),Ⅵ区和颈侧区淋巴结阳性率比较,差异有统计学意义(配对 x~2检验,x~2=33.01,P<0.01)。统计分析表明颈侧区淋巴转移和Ⅵ区淋巴转移无相关性(独立 x~2检验,x~2=2.08,Pearson 列联系数 C=0.14,P>0.05)。10年、15年生存率分别为88.3%和84.5%。结论分化型甲状腺癌Ⅵ区与颈侧区(Ⅱ-Ⅴ区)淋巴转移率不同。不能仅从Ⅵ区转移判断颈侧区是否有转移。发生Ⅵ区淋巴转移的患者不比颈侧区(Ⅱ-Ⅴ区)淋巴转移的预后差,经过正确的外科治疗,预后较好。
Objective To investigate the characteristics of cervical lymph node metastasis in the area Ⅵ and the neck of the differentiated thyroid carcinoma (Ⅱ-V), so as to provide the basis for choosing the correct surgical method. Methods A retrospective analysis of March 1984 to December 2000, 99 cases of thyroid cancer patients in Liaoning Provincial Tumor Hospital, head and neck surgery for the first time surgery, simultaneous neck dissection, pathological examination, follow-up, and the results were statistically analyzed . Results Among the 99 cases of differentiated thyroid carcinoma, there were 61 cases of papillary thyroid carcinoma (one case of bilateral papillary thyroid carcinoma), 13 cases of papillary follicular mixed type and 25 cases of follicular thyroid carcinoma. According to 2002 UICC TNM staging: stage Ⅰ 60 cases, stage Ⅱ 1 case, stage Ⅲ 5 cases, stage Ⅳ 33 cases. One side of the gland and isthmus resection in 80 cases, one side of the lobes and contralateral most or subtotal resection in 15 cases, 4 cases of total thyroidectomy. All patients underwent synchronous neck dissection on 104 sides (double neck dissection in 5 cases), including 66 cases of classic dissection (68 sides) and 33 cases of modified dissection (36 sides). Postoperative pathological examination 83 cases (86 sides) were positive lymph nodes, of which 3 cases were positive for bilateral lymph nodes and the rate of cervical lymph node metastasis was 83.8% (83/99). The positive rate of Ⅵ region was 37.5% (39/104), the positive rate of cervical region (Ⅱ-Ⅴ region) was 76.9% (80/104), the positive rate of Ⅵ region and cervical region lymph node was statistically significant (paired x ~ 2 test, x ~ 2 = 33.01, P <0.01). Statistical analysis showed no correlation between cervical lymph node metastasis and lymph node metastasis in Ⅵ (independent x ~ 2 test, x ~ 2 = 2.08, Pearson’s correlation coefficient C = 0.14, P> 0.05). The 10-year and 15-year survival rates were 88.3% and 84.5% respectively. Conclusion Differentiated thyroid carcinoma Ⅵ area and the neck side area (Ⅱ-Ⅴ area) lymph node metastasis rate. Can not just transfer from the Ⅵ area to determine whether there is metastasis of the lateral neck area. The incidence of lymph node metastasis in Ⅵ area than the lateral (Ⅱ-Ⅴ) lymph node metastasis, the prognosis is poor, after the correct surgical treatment, the prognosis is good.