分化型甲状腺癌侧颈淋巴结的规范性清扫
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摘要
甲状腺癌近年来发病率逐渐增高,其中分化型甲状腺癌(DTC)约占95%。DTC包括甲状腺乳头状癌(PTC)和滤泡状癌(FTC),前者约占90%。多数PTC相对惰性、进展缓慢、预后良好,但易出现颈部淋巴结转移,其中侧颈淋巴结转移率高达64.2%。规范、彻底的侧颈淋巴结清扫术是治疗DTC的重要手段,不规范的侧颈清扫是造成DTC术后复发转移的主要原因。
The incidence of thyroid carcinoma is increasing every year and differentiated thyroid carcinoma(DTC) accounts for about 95% of all thyroid cancers. DTC consists of papillary thyroid carcinoma(PTC) accounting for more than 90% and follicular carcinoma(FTC). Most cases of PTC are relatively inert with slow progression and good prognosis, but cervical lymph node metastasis occurs early. Lateral lymph node metastasis occurs in 64.2% of patients. Currently, rational and radical lateral cervical lymph node dissection is the surgical protocol for DTC. Postoperative recurrence is mainly caused by the "non-standard" dissection.
The incidence of thyroid carcinoma is increasing every year and differentiated thyroid carcinoma(DTC) accounts for about 95% of all thyroid cancers. DTC consists of papillary thyroid carcinoma(PTC) accounting for more than 90% and follicular carcinoma(FTC). Most cases of PTC are relatively inert with slow progression and good prognosis, but cervical lymph node metastasis occurs early. Lateral lymph node metastasis occurs in 64.2% of patients. Currently, rational and radical lateral cervical lymph node dissection is the surgical protocol for DTC. Postoperative recurrence is mainly caused by the "non-standard" dissection.
引文
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[17] 张浩,孙威.颈淋巴结清扫术易遗漏转移淋巴结部位及其对策[J].中国实用外科杂志,2017,37(9):965-970.
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[19] 韦伟,李朋.甲状腺癌颈淋巴结清扫术常见并发症及其防治[J].中国实用外科杂志,2017,37(9):970-973.
[2] 朱一鸣,蔺晨,王健,等.甲状腺乳头状癌侧颈部淋巴结二次清扫的治疗经验[J].中国医刊,2016,51(6):59-63.
[3] KIM SK,PARK I,HUR N,et al.Patterns,predictive factors,and prognostic impact of contralateral lateral lymph node metastasis in N1b papillary thyroid carcinoma[J].Ann Surg Oncol,2017,24(7):1943-1950.
[4] KUPFERMAN ME,PATTERSON M,MANDEL SJ,et al.Patterns of lateral neck metastasis in papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg,2004,130(7):857-860.
[5] ESKANDER A,MERDAD M,FREEMAN JL,et al.Pattern of spread to the lateral neck in metastatic well-differentiated thyroid cancer:A systematic review and meta-analysis[J].Thyroid,2013,23(5):583-592.
[6] PATRON V,HITIER M,BEDFERT C,et al.Occult lymph node metastases increase loco regional recurrence in differentiated thyroid carcinoma[J].Ann Otol Rhinol Laryngol,2012,121(5):283-290.
[7] GIRARDI FM,BARRA MB,ZETTLER CG,et al.Predictive factors for lymph node metastasis in solitary papillary thyroid carcinomas:A retrospective study[J].Pathol Oncol Res,2015,21(1):59-64.
[8] PODNOS YD,SMITH D,WAGMAN LD,et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg,2005,71(9):731-734.
[9] ZAYDFUDIM V,FEURER ID,GRIFFIN MR,et al.The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J].Surgery,2008,144(6):1070-1078.
[10] HAUGEN BR,ALEXANDER EK,BIBLE KC,et al.2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer [J].Thyroid,2016,26(1):1-133.
[11] 中华医学会内分泌学分会,中华医学会外科学分会内分泌外科学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[12] JAVID M,GRAHAM E,MALINOWSKI J,et al.Dissection of levels through Vis required for optimal outcomes in patients with lateral neck lymph node metastasis from papillary thyroid carcinoma [J].J Am Coll Surg,2016,222(6):1066-1073.
[13] KOO BS,YOON YH,KIM JM,et al.Predictive factors of level IIb lymph node metastasis in patients with papillary thyroid carcinoma[J].Ann Surg Oncol,2009,16(5):1344-1347.
[14] KUPFERMAN ME,WEINSTOCK YE,SANTILLAN AA,et al.Predictors of level V metastasis in well- differentiated thyroid cancer[J].Head Neck,2008,30(11):1469-1474.
[15] KHAFIF A,MEDINA JE,ROBBINS KT,et al.Level V in therapeutic neck dissections for papillary thyroid carcinoma[J].Head Neck,2013,35(4):605-607.
[16] LIM YC,CHOI EC,YOON YH,et al.Occult lymph node metastases in neck level V in papillary thyroid carcinoma[J].Surgery,2010,147(2):241-245.
[17] 张浩,孙威.颈淋巴结清扫术易遗漏转移淋巴结部位及其对策[J].中国实用外科杂志,2017,37(9):965-970.
[18] TUFANO RP,CLAYMAN G,HELLER KS,et al.Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer:A critical review of the risks and benefits of surgical intervention versus active surveillance[J].Thyroid,2015,25(1):15-27.
[19] 韦伟,李朋.甲状腺癌颈淋巴结清扫术常见并发症及其防治[J].中国实用外科杂志,2017,37(9):970-973.