摘要目的 探讨甲状腺乳头状癌颈淋巴结转移模式以及全甲状腺切除+功能性颈淋巴结清扫术在甲状腺乳头状癌治疗中的作用.方法 回顾性分析一期全甲状腺切除+功能性颈淋巴结清扫术治疗的172例甲状腺乳头状癌患者的临床和病理资料.结果 172例患者的219侧功能性颈淋巴结清扫结果提示颈淋巴结转移率依次为Ⅵ区(96.3%)、Ⅳ区(78.5%)、Ⅲ区(62.1%).肿瘤浸润甲状腺被膜者颈淋巴结转移率明显增高(P＜0.05).124例术后1 d血清甲状旁腺素(15.87±8.03)pg/ml较术前(37.68±15.0)pg/ml显著降低(P＜0.01).患者5年、10年和15年的生存率分别为(98.83±0.82)%、(98.23±1.02)%和(96.42±1.43)%.结论 术中快速冰冻切片是确定Ⅵ区淋巴结病理状态的可靠方法.准确掌握全甲状腺切除+功能性颈淋巴结清扫术的适应证,术后患者可获得长期生存.

abstractsObjective To explore the pattern of cervical nodal metastasis and the clinical significance of total thyroidectomy plus functional neck lymphadenectomy in papillary thyroid carcinoma patients. Methods Clinical and pathological data of 172 patients with papillary thyroid cancer who underwent total thyroidectomy plus functional neck lymph node dissection at Jinan Military General Hospital were retrospectively reviewed, including patient demographics, extent of surgery, parathyroid hormone level,recurrence, tumor pathology, such as tumor size, multifocality, capsular invasion, vascular invasion,extrathyroidal extension, and lymph node status. Results Of the 172 functional neck dissection patients (47 ambilateral), the incidence of lymphonodus metastasis in regions Ⅵ, Ⅳ and Ⅲ was 96. 3% ,78. 5%and 62.1% respectively. Rate of nodal metastasis was higher in patients with extracapsular invasion than in patients with no invasion ( P ＜ 0. 05 ). Serum parathyroid hormone levels significantly decreased immediately postoperatively in total thyroidectomy plus functional neck dissection and remained low for several weeks thereafter ( P ＜ 0. 01 ). The 5-, 10- and 15-year survival rate was ( 98. 83 ± 0. 82) %, (98. 23 ± 1.02 ) % and (96. 42 ± 1.43 )%, respectively. Conclusions Therapeutic neck lymph node dissection for papillary thyroid cancer is recommended for cervical nodal metastasis patients. Total thyroidectomy plus functional neck dissection is important in the treatment of papillary thyroid cancer.