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目的探讨Ⅲ、Ⅳ区淋巴结活检在分化型甲状腺癌颈淋巴结清扫术中的意义。方法428例分化型甲状腺癌患者均行双侧甲状腺切除+Ⅵ区淋巴结清扫术,其中232例行Ⅲ、Ⅳ区淋巴结活检(B组),196例未行Ⅲ、Ⅳ区淋巴结活检(A组)。根据术中活检(B组)和术前B超(A组)结果,颈淋巴结转移患者行侧颈区淋巴结清扫术。结果 B组行侧颈区淋巴结清扫术比例高于A组(38.36%vs.23.47%)(P<0.01),未行侧颈区淋巴结清扫术而再次手术例数少于A组(P<0.01)。B组颈淋巴结转移率达38.36%,颈淋巴结转移与肿瘤直径呈正相关(r=0.96,P<0.05)。结论Ⅲ、Ⅳ区淋巴结活检提高分化型甲状腺癌患者颈淋巴结转移的诊断,减少因术后残留转移淋巴结而再次手术的需要。
Objective To investigate the significance of Ⅲ and Ⅳ lymph node biopsy in differentiating cervical lymph node dissection of thyroid cancer. Methods A total of 428 patients with differentiated thyroid cancer underwent bilateral thyroidectomy plus Ⅵ lymph node dissection. Of 232 patients, Ⅲ and Ⅳ lymph node biopsy (group B) and 196 patients without Ⅲ and Ⅳ lymph node biopsy (group A) . According to the results of intraoperative biopsy (group B) and preoperative ultrasound (group A), neck lymph node dissection was performed in patients with cervical lymph node metastasis. Results The proportion of lymphadenectomy in group B was significantly higher than that in group A (38.36% vs.23.47%, P <0.01). The number of reoperation was less in group B than in group A (P <0.01) ). The rate of cervical lymph node metastasis in group B was 38.36%. There was a positive correlation between cervical lymph node metastasis and tumor diameter (r = 0.96, P <0.05). Conclusion Lymph node biopsy in stage Ⅲ and Ⅳ can improve the diagnosis of cervical lymph node metastasis in patients with differentiated thyroid cancer and reduce the need of reoperation due to residual lymph node metastasis after operation.