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目的探讨甲状腺癌纵隔淋巴转移的发病特点和治疗方法。方法回顾性分析中国医学科学院肿瘤医院1985年1月—2004年10月诊断为甲状腺癌纵隔淋巴转移122例患者的临床资料。分析其基本情况、诊断、术式、病理结果、并发症和预后,并比较胸骨劈开(34例)和颈部入路上纵隔清扫(88例)两种术式的并发症、生存率和复发情况。结果按美国胸科协会纵隔分区,上纵隔(2R/2L 区)受累最为常见,占98.4%(120/122)。有20.5%(25/122)病例有下纵隔受累,主要是左、右下气管旁淋巴结(4R/4L)区。胸骨劈开组并发症发生率38.2%(13/34)高于颈部入路组28.4%(25/88),但与纵隔手术有关的并发症仅有胸腔积液3例、纵隔感染1例、上腔静脉损伤1例,均痊愈。全组病例随访时间12～249个月,中位随访时间60个月。失访9例,随访率92.6%。采用 Kaplan-Meier 法计算生存率。劈胸骨劈开组(34例)5年生存率中,分化型甲状腺癌(22例)90.9%,髓样癌(12例)87.1%;颈部入路组(88例)5年生存率中,分化型甲状腺癌(76例)85.4%,髓样癌(12例)92.3%,两种病理类型组间的生存率差异均无统计学意义(P 值分别为0.252和0356)。胸骨劈丌组3年、5年复发率为3.8%、12.2%,颈部入路组为7.9%、14.2%,组间差异无统计学意义(P=0.504)。结论甲状腺癌纵隔淋巴转移的病例下纵隔受累并不少见。这部分患者颈部入路手术困难,应积极行胸骨劈开纵隔清扫术。对于仅局限在上纵隔的病灶,胸骨劈开入路纵隔清扫未能明显改善生存率,但因其术野暴露好,适用于转移淋巴较多,或与大血管关系密切的患者。
Objective To investigate the incidence and treatment of mediastinal lymphatic metastasis in thyroid cancer. Methods The clinical data of 122 patients diagnosed as mediastinal lymphatic metastasis of thyroid cancer from January 1985 to October 2004 in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. The complications, survival rate and recurrence were compared between the two cases of sternotomy (34 cases) and mediastinal dissection of the neck (88 cases) Happening. The results of the American Thoracic Society mediastinal partition, the mediastinum (2R / 2L area) involvement of the most common, accounting for 98.4% (120/122). There are 20.5% (25/122) cases of mediastinal involvement, mainly left and right lower paratracheal lymph nodes (4R / 4L) area. The incidence of complications in the sternome split group was 38.2% (13/34), which was higher than that in the cervical approach group (28.4%, 25/88). However, the complications associated with mediastinal surgery were only pleural effusion in 3 cases and mediastinal infection in 1 case , 1 case of superior vena cava injury, were cured. All patients were followed up for 12 to 249 months with a median follow-up of 60 months. Nine cases were lost to follow-up, with a follow-up rate of 92.6%. Survival was calculated using Kaplan-Meier method. The 5-year survival rates of differentiated thyroid cancer (22 cases) were 90.9%, that of medullary carcinoma (87 cases) was 87.1%, and that of cervical approach group (88 cases) was 5 years , Differentiated thyroid cancer (76 cases) 85.4% and medullary carcinoma (92 cases) 92.3%. There was no significant difference in survival rates between the two pathological types (P = 0.252 and 0356, respectively). There was no significant difference between the two groups (P = 0.504). There was no significant difference between the two groups (P> 0.05). Conclusions Mediastinal involvement of the mediastinal lymph node in thyroid cancer is not uncommon. This part of patients with neck surgery difficult, active sternotomy should be split cleft dissection. For the limitations of the mediastinum only, mediastinal suture removal of the sternum does not significantly improve survival, but because of exposure to the operative field, it is suitable for patients with more metastatic lymph nodes or with greater blood vessels.