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目的 研究右喉返神经后方淋巴结清扫在cN0期甲状腺乳头状微小癌(PTMC)中中央区淋巴结清扫手术中的治疗意义.方法 回顾性分析了2010至2015年间初治的305例cN0期甲状腺乳头状微小癌患者临床资料,对其中央区(喉返神经前方Ⅵa区、喉返神经后方Ⅵb区)转移率及临床病例情况等进行统计分析.结果 305例 cN0期PTMC 患者行甲状腺全切加双侧中央区清扫或右侧腺叶切除加同侧中央区清扫,肿瘤中位直径为6.75 mm.中央区总转移率为35%,右喉返神经后方淋巴结转移率为11.1%.患者男女性别、年龄<45岁、肿瘤直径≥0.8 cm、双侧多发病灶、有被膜侵犯,Ⅵa转移淋巴结≥3,均为PTMCⅥb区转移的相关风险因素(χ2值分别为6.913、4.241、4.517、5.185、12.400、34.745, P均<0.05).结论 由于PTMC患者中央区淋巴结转移率相对较高以及术前对中央区转移评估存在不足,故对于肿瘤≥0.8 cm、多发病灶、存在被膜侵犯及右中央区浅层淋巴结转移个数≥3的尤其是男性甲状腺乳头状微小癌患者行中央区淋巴清扫时应包括喉返神经后方区域.

Objective To assess the significance of the right paraesophageal node(Ⅵb area) dissection in cN0 stage papillary thyroid microcarcinoma(PTMC)central lymph node dissection.Methods The clinical data of three hundred and five cN0 PTMC patients who underwent radical thyroidectomy from 2010 to 2015 was retrospectively analyzed.The metastasis rate of central compartment(Ⅵa area.Ⅵb area)and the clinical data were collected and analyzed.Results 305 cN0 stage PTMC patients underwent total thyroidectomy and bilateral central compartment dissection or right lobectomy combined with ipsilateral central compartment dissection,the mean diameter of the tumors was 6.75 mm.The incidence rate of central compartment metastasis was 35%.The incidence rate ofⅥb area metastasis was 11.1%.The status ofⅥb area metastasis was correlated with major clinicopathologic parameters such as sex,age<45,tumor diameter≥0.8 cm,bilateral multiple lesions, capsule invasion,VI a lymph node metastasis≥3 were all related risk factors of PTMC VIb area metastasis(χ2=6.913,4.241,4.517,5.185,12.400,34.745,P<0.05).Conclusion Because of the high rate of central lymph node metastasis in patients with PTMC and the poor efficiency in the evaluation for central lymph node metastasis before operation,the right paraesophageal lymph nodes(Ⅵb area)dissection is needed to be done in cN0 stage PTMC patients with tumor size≥0.8 cm,multifocal lesions,membrane invasion,Ⅵa area metastasis≥3,especially male patients.