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

摘要

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% v s .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 lymph node biopsy(LNB) of Ⅲ and Ⅳareas during cervical lymph node dissection (CLND ) in the patients with differentiated thyroid carcinoma(DTC) .Methods A total of 428 DTC patients underwent bilateral thyroid resection plus LNB of VI area ,of which 232 patients(group B) were given intraoperative LNB of III and IV areas , and 196 cases(group A) were not as the controls .The lateral neck CLND was performed according to the results of intraoperative biopsy in group B or that of preoperative ultrasound in group A .Results The percentage underwent lateral neck CLND was higher in group B than that in group A(38.36% vs . 23.47% )(P＜0 .01) ,but the number of patients underwent reoperation due to cervical lymph node metastasis was less in group B than that in group A(P＜0 .01) .The metastasis rate of cervical lymph nodes in group B was 38.36% ,which was positively correlated to tumor diameter ( r=0 .96 , P＜0 .05) .Conclusion LNB of Ⅲ and Ⅳ areas improves the diagnosis of cervical lymph node metastasis in the patients with DTC and reduces the needs for reoperation because of residual metastasis lymph nodes .