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目的探讨微小乳头状甲状腺癌手术行颈部淋巴结清扫术的必要性。方法分析1999年5月～2009年10月收治的微小乳头状甲状腺癌手术患者的临床病理资料。分为单发灶组(42例)和多发灶组(27例),均行中央组(Ⅵ区)、同侧或双侧颈深组(Ⅲ+Ⅳ区)淋巴结清扫术。结果Ⅵ区淋巴结转移发生率单发灶组与多灶组分别为2例(4.8%)与7例(25.9%),Ⅲ+Ⅳ区淋巴结转移发生率单发灶组与多发灶组分别为0例(0)与3例(11.1%)。两组Ⅵ,Ⅲ+Ⅳ区淋巴结转移率差异具有统计学意义(P<0.05)。术后4例发生一过性低钙血症,3例短暂性喉返神经麻痹,1例淋巴瘘,1例多灶组术后7个月复发,1例单灶组术后42个月复发。无1例死亡病例。结论多发灶性的微小癌应积极施行淋巴结清扫;单发灶性微小癌可在定期随诊观察下暂不行预防性的颈淋巴结清扫术,既不会影响患者的生存率又能提高生存质量。
Objective To investigate the necessity of cervical lymphadenectomy in the treatment of minimal papillary thyroid carcinoma. Methods Clinical data of patients with minimal papillary thyroid carcinoma who were treated from May 1999 to October 2009 were analyzed. The patients were divided into single group (n = 42) and multiple group (n = 27). Lymph node dissection was performed in central group (Ⅵ), ipsilateral or bilateral neck deep group (Ⅲ + Ⅳ). Results The incidence of lymph node metastasis in Ⅵ region was 2 cases (4.8%) and 7 cases (25.9%) respectively in single tumor group and multifocal group. The incidence of lymph node metastasis in group Ⅲ + Ⅳ was 0 Cases (0) and 3 cases (11.1%). There were significant differences in lymph node metastasis rates between the two groups (Ⅵ, Ⅲ + Ⅳ) (P <0.05). Postoperative 4 patients had transient hypocalcemia, 3 cases of transient laryngeal nerve paralysis, 1 case of lymphatic fistula, 1 case of multifocal group relapsed 7 months after operation, and 1 case of single group recurred 42 months after operation . No one deaths. Conclusions Multifocal micro-cancer should be actively performed lymph node dissection. Single micro-cancer of the lesion can not be prophylactic cervical lymph node dissection at regular follow-up, which will not affect the survival rate of patients and improve the quality of life.