上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (2): 180-.doi: 10.3969/j.issn.1674-8115.2018.02.012

• 论著（临床研究） • 上一篇    下一篇

颈部中央区淋巴结清扫及术中冰冻病理检查在甲状腺微小乳头状癌治疗中的临床价值

潘先均 1 ，胡代星 2 ，苏新良 2   

  1. 1. 重庆大学附属肿瘤医院，重庆市肿瘤研究所，重庆市肿瘤医院，重庆 400030；2. 重庆医科大学附属第一医院内分泌乳腺外科 , 重庆 400016
  • 出版日期:2018-02-28 发布日期:2018-03-09
  • 通讯作者: 苏新良，电子信箱：suxinliang@21cn.com。
  • 作者简介:潘先均（1986—），男，住院医师，硕士；电子信箱：swpj@tom.com。
  • 基金资助:
    重庆市科学技术委员会研究项目（cstc2017shmsA130066）

Clinical value of central lymph node dissection and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma

PAN Xian-jun1 , HU Dai-xing2 , SU Xin-liang2   

  1. 1. Chongqing University Cancer Hospital; Chongqing Cancer Institute; Chongqing Cancer Hospital, Chongqing 400030, China; 2. Department of Endocrine Breast Surgery, First Affiliated Hospital of Chongqing Medical University , Chongqing 400016, China
  • Online:2018-02-28 Published:2018-03-09
  • Supported by:
    Foundation of Chongqing Science and Technology Commission, cstc2017shmsA130066

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摘要： 目的 · 探讨清扫颈部中央区淋巴结及术中冰冻病理检查在甲状腺微小乳头状癌治疗中的临床价值。方法 · 回顾性分析重庆医科大学附属第一医院内分泌乳腺外科 2012 年 10 月—2015 年 11 月由同一位外科医师手术治疗的 187 例甲状腺微小乳头状癌初治患者的临床资料与颈部淋巴结转移情况。结果 · 187 例患者中 94 例术后病理证实存在中央区淋巴结转移，转移率为 50.2%。不同性别、年龄患者间的中央区淋巴结转移率差异无统计学意义（均 P>0.05）；而肿瘤为多中心病灶、直径 >5 mm、侵犯包膜、肿瘤位于腺叶下极时，中央区淋巴结转移率显著增高（均 P<0.05）。69 例患者同期行颈侧区淋巴结清扫，其中 22 例被证实存在颈侧区淋巴结转移；这 22 例患者中，中央区淋巴结转移数≥ 2 枚者，伴有颈侧区淋巴结转移的风险显著增高（P<0.05）。术中冰冻病理检查对中央区淋巴结转移的诊断水平较现行颈部淋巴结阴性 (cN0) 标准高（P<0.05），其假阴性率（20.2%）显著低于现行 cN0 标准（88.8%）；其与术后病理检查对中央区淋巴结转移的诊断结果具有高度一致性（K=0.765，P=0.000）。结论 · 甲状腺微小乳头状癌有较高的颈部中央区淋巴结转移率，建议常规清扫中央区。术中中央区淋巴结冰冻病理检查可较准确地评估颈部淋巴结的转移状态，有助于指导甲状腺及颈部淋巴结的手术范围。

关键词: &ensp, 甲状腺微小乳头状癌；中央区淋巴结清扫；术中冰冻病理检查；颈部淋巴结阴性

Abstract:

] Objective · To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC). Methods · Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery, First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively. Results · Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region, and the metastasis rate was 50.2%. Furthermore, lymph node metastasis rate in central region was not associated with gender and age (P>0.05), but the metastasis rates of the patients with multifocal lesion, tumor diameter greater than 5 mm, capsular invasion, or tumor location in the lower third of thyroid lobe were higher (P<0.05). Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region. When the number of lymph node metastases in the central region was greater than or equal to 2, the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P<0.05). The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P<0.05), which had lower false negative rate (20.2%) than current cN0 standard (88.8%) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765, P=0.000). Conclusion · PTMC has high lymph node metastasis rate in the central region. Regular CLND is recommended. Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.

Key words: papillary thyroid microcarcinoma, central lymph node dissection, intraoperative frozen-section examination, cervical lymph node-negative