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目的探讨c N0甲状腺微小乳头状癌(PTMC)病人右侧喉返神经浅面(Ⅵa区)及深面(Ⅵb区)淋巴结转移的相关危险因素。方法回顾性分析2012年1月至2015年2月四川大学华西医院甲状腺乳腺外科治疗的294例初诊c N0 PTMC病人的临床资料。均至少行右侧中央区淋巴结清扫。分析右侧Ⅵa区及Ⅵb区淋巴结转移的相关危险因素。结果中央区淋巴结转移发生率为40.9%,Ⅵa区为23.5%,Ⅵb区为8.5%。浸润甲状腺被膜与Ⅵa、Ⅵb区淋巴结转移无关。右叶PTMC(193例)肿瘤直径>7 mm、气管前淋巴结转移为Ⅵa区淋巴结转移的独立危险因素,气管前、Ⅵa区淋巴结转移是Ⅵb区淋巴结转移的独立危险因素。左叶PTMC(68例):无Ⅵb区转移者;气管前、喉前淋巴结转移是Ⅵa区淋巴结转移的独立危险因素(P<0.05)。双叶PTMC(33例):无Ⅵa、Ⅵb区淋巴结转移相关危险因素。结论对于c N0 PTMC病人,右叶PTMC直径>7 mm、气管前淋巴结转移,或左叶PTMC气管前、喉前淋巴结转移,建议清扫Ⅵa区淋巴结;右叶PTMC气管前、Ⅵa区淋巴结转移,建议清扫Ⅵb区淋巴结;左叶PTMC一般不发生Ⅵb区转移。
Objective To investigate the risk factors of lymph node metastasis in the superficial (Ⅵa) and deep (Ⅵb) regions of the right recurrent laryngeal nerve in patients with cN0 thyroid papillary carcinoma (PTMC). Methods The clinical data of 294 newly diagnosed c N0 PTMC patients from January 2012 to February 2015 in West China Hospital of Sichuan University were analyzed retrospectively. At least the right central lymph node dissection. Analysis of the right Ⅵ a and Ⅵ b area lymph node metastasis-related risk factors. Results The incidence of lymph node metastasis was 40.9% in central area, 23.5% in Ⅵa area and 8.5% in Ⅵb area. Invasive thyroid capsule and Ⅵ a, Ⅵ b lymph node metastasis unrelated. The diameter of tumor in the right lobe PTMC (193 cases) was> 7 mm, and the anterior tracheal lymph node metastasis was an independent risk factor for lymph node metastasis in Ⅵa region. Lymph node metastasis in Ⅵa region was an independent risk factor for Ⅵb lymph node metastasis. Left lobe PTMC (68 cases): no Ⅵ b area transfer; pre-tracheal and anterior laryngeal lymph node metastasis in Ⅵ a regional lymph node metastasis was an independent risk factor (P <0.05). Futaba PTMC (33 cases): No Ⅵa, Ⅵb lymph node metastasis-related risk factors. Conclusions For c NO PTMC patients, right anterior lobe PTMC diameter> 7 mm, pre-tracheal lymph node metastasis, or left tracheal PTMC tracheal anterior and pre-laryngeal lymph node metastasis, it is recommended to clean VIa lymph nodes; right PTMC tracheal anterior trachea, VIa lymph node metastasis Ⅵ b area lymph node dissection; left lobe PTMC generally does not occur Ⅵ b area transfer.