Extent of routine central lymph node dissection with small papillary thyroid carcinoma
Extent of routine central lymph node dissection with small papillary thyroid carcinoma
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DOI：
10.1007/s00268-007-9171-7
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发表时间：
2007-10-01
影响因子：
2.6
通讯作者：
Chung, Ki-Wook
中科院分区：
文献类型：
--
作者：
Lee, Yong Sang;Kim, Seok Won;Chung, Ki-Wook
甲状腺乳头状癌（PTC）患者常规淋巴结清扫的适应症和范围尚不清楚。本研究的目的是探讨小PTC患者中央淋巴结清扫（CLND）的程度与治疗效果和潜在风险之间的关系。103例PTC < 2cm行甲状腺全切除术合并常规CLND的患者分为常规双侧CLND组（I组）和同侧CLND组（II组）。以淋巴结转移程度和甲状腺切除术后血清甲状腺球蛋白浓度评价治疗效果。术后症状性低钙患者被认为是术后甲状旁腺功能低下，并接受钙/维生素D治疗。总的来说，I组21例患者中有12例（57.1%）和II组75例患者中有48例（64.0%）甲状腺切除术后血清甲状腺球蛋白浓度< 1.0 ng/ml；ⅰ组21只中有17只（81.0%）、ⅱ组75只中有60只（80.0%）的血药浓度< 2.0 ng/ml。ⅰ组25例患者中有12例（48.0%）出现低钙血症症状，ⅱ组78例患者中有16例（20.5%）出现低钙血症症状（p = 0.009）。对于小ptc患者，CLND的范围不影响治疗效果，但接受双侧CLND的患者显示一过性甲状旁腺功能低下的发生率增加。这些结果表明，对于小PTC患者，更保守的常规CLND与更广泛的CLND一样安全。
The indications for and extent of routine lymph node dissection in patients with papillary thyroid carcinoma (PTC) are unclear. The aim of this study was to investigate the association between the extent of central lymph node dissection (CLND) and the therapeutic effects and potential risks in patients with a small PTC. A total of 103 patients with a PTC < 2 cm who underwent total thyroidectomy with routine CLND were divided into those who underwent routine bilateral CLND (group I) and those with ipsilateral CLND (group II). Therapeutic efficacy was evaluated by the extent of lymph node metastasis and postthyroidectomy serum thyroglobulin concentration. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. Altogether, 12 of 21 patients (57.1%) in group I and 48 of 75 (64.0%) in group II had postthyroidectomy serum thyroglobulin concentrations < 1.0 ng/ml; furthermore, 17 of 21 (81.0%) in group I and 60 of 75 (80.0%) in group II had concentrations < 2.0 ng/ml. Hypocalcemia symptoms were identified in 12 of 25 patients (48.0%) in group I and in 16 of 78 (20.5%) in group II (p = 0.009). The extent of the CLND did not influence the therapeutic effects in patients with small PTCs, but those who underwent bilateral CLND showed an increased rate of transient hypoparathyroidism. These findings indicate that the more conservative routine CLND is as safe as more extensive CLND for patients with a small PTC.