【作者】 韩慧；

【导师】 陈光；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 甲状腺恶性肿瘤占全身恶性肿瘤的1.3%,是内分泌系统最常见的肿瘤,分为四种病理类型,甲状腺乳头状癌是甲状腺癌中最常见的,属低度恶性肿瘤,其与甲状腺滤泡状癌统称分化型甲状腺癌,如果严格按照病理学的诊断标准,约2/3的甲状腺乳头状癌的病理实际上是混合型肿瘤,在其病灶中可发现不同比例的滤泡状癌的组分,这些病人的自然病程与乳头状癌相似,目前的分类标准将这部分归入乳头状癌中。分化型甲状腺癌颈部淋巴结转移较多、较早,对于前哨淋巴结定位及颈部淋巴结的清扫范围国内外仍存在争议。本文对2003年11月-2009年3月吉林大学第一医院普外科收治并获得随访的295例分化型甲状腺癌患者进行分析,认为颈部淋巴结Ⅵ区为分化型甲状腺癌前哨淋巴结之一,年龄≥45岁、临床淋巴结转移阳性、未行淋巴结清扫术为分化型甲状腺癌复发的高发因素。对于cN0期DTC患者,应行甲状腺患侧叶全切+对侧次全切+Ⅵ区淋巴结清扫术;对于cN1期DTC患者,应行甲状腺患侧叶全切+对侧次全切+功能性淋巴结清扫术。更多还原

【Abstract】 Objective:To evaluate reasonable extent of lymph node dissection of differentiated thyroid carcinoma (DTC), post-operational recurrence-related factors, the sentinel lymph node (SLN) region and regulate the significance of SLN. Material and Methods:From Nov. 2003 to Apr. 2009, consecutive 295 patients with DTC being performed surgical operation, were concluded retrospectively. We analyze the significance between the prognosis-related factors (sex、age、cN0 or cN1 and extent of lymph node dissection) and the recurrence rates, and then discuss the region of SLN.Results:In the 295 patients with DTC, 157 cases metastasised to lymph node, the rate is 53.2%. 51 cases(32.5%) metastasised to lymph node levelⅥ, 29 cases (18.5%) metastasised to lymph node levelⅣ, 77 cases (49%) metastasised to lymph node levelⅡ~Ⅵ. The incidence of metastasition to lymph node levelⅥis higher than lymph node levelⅣ. The recrudescent incidence between man and woman is not different. The recrudescent incidence of the patients who are older than 45y is higher than the incidence of the ones who are younger. For the patients in clinically negative node (cN0) stage, the incidence of recrudescent cases with R0 (near-total thyroidectomy without node dissection) is higher than R1 (near-total thyroidectomy with prophylactic (levelⅥ) lymph node dissection)(P<0.05); the incidecence of recrudescent cases with R1、R2 (near-total thyroidectomy with modified radical lymph node dissection) and R3 (near-total thyroidectomy with comprehensive lymph node dissection) is no difference (P>0.05); For the patients in cN1 stage, the difference of recrudescent incidence cases with R2 and R3 is not statistically significant (P>0.05). In one sentence, the recurrent rate of DTC is closely related with age, clinical node stage, and the extent of lymph nodes dissection.Conclusion:Lymph node levelⅥbelongs to SLN. The higher recurrence rate of DTC is closely related with age≥45, clinically positive node stage, and operation without node dissection. From our study, we found that the optimized prognosis of the patients whose preoperative diagnosis was cN0 stage had signficant relationship with near-total thyroidectomy procedure with prophy- lactic (levelⅥ) node dissection. The patients that preoperative diagnosis was cN1 stage got benefits from the thyroidectomy procedure simultaneously with the modified radical lymph node dissection.更多还原