Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients.
Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients.
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发表时间：
2012-07
影响因子：
6.1
通讯作者：
Xiaolei Wang;Zhengang Xu;Yue-huang Wu;Shaoyan Liu;Yue Yu
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作者：
Xiaolei Wang;Zhengang Xu;Yue-huang Wu;Shaoyan Liu;Yue Yu
背景甲状腺癌咽旁淋巴结转移是罕见的。我们描述了这种情况的临床特征，诊断和手术治疗。方法1999年1月至2010年12月收治25例甲状腺癌PPLN转移患者，其中乳头状癌22例，髓样癌2例，滤泡状癌1例。其中16例在PPLN转移前有手术治疗史。无手术史的9例患者中，5例有广泛的颈部淋巴结转移，4例有隐匿性甲状腺乳头状癌。22例经增强CT确诊为PPLN转移。结果23例经颈动脉入路切除转移瘤，2例经下颌动脉入路切除转移瘤。中位随访时间为31个月（范围：6 - 130个月）后，9例患者发生远处转移，其中6例死于疾病。5年生存率为63.8%。结论甲状腺癌的PPLN转移可能发生在以下患者中：既往接受过颈淋巴结清扫术、初始治疗前颈淋巴结广泛转移以及隐匿性甲状腺癌。增强CT有助于前两种表现的诊断。手术切除仍是治疗本病的主要手段。PPLN转移有与远处转移和不良预后相关的倾向。
BACKGROUND Parapharyngeal lymph node (PPLN) metastasis from thyroid carcinoma is rare. We describe the clinical features, diagnosis, and surgical treatment of this condition. METHODS Twenty-five patients with PPLN metastasis from thyroid carcinoma were treated at our institution from January 1999 to December 2010, including 22 patients with papillary carcinoma, two with medullary carcinoma, and one with follicular carcinoma. Of these, 16 had a history of surgical treatment prior to PPLN metastasis. Of the nine patients without a history of surgical treatment, five had widespread cervical lymph node metastases and four had occult papillary thyroid carcinoma. PPLN metastasis was diagnosed by enhanced computed tomography in 22 cases. RESULTS Resection of metastases was performed via a transcervical approach in 23 patients and a transmandibular approach in two patients. After a median follow-up time of 31 months (range: 6 - 130 months), nine patients developed distant metastases, and six of these died of their disease. The 5-year survival rate was 63.8%. CONCLUSIONS PPLN metastasis from thyroid carcinoma may occur in patients: with previous neck dissection, with widespread metastases to cervical lymph nodes prior to initial treatment, and with occult thyroid carcinoma. Enhanced computed tomography is helpful for diagnosis in the first two presentations. Surgical resection remains the mainstay of treatment for this disease. PPLN metastasis has a tendency to be associated with distant metastases and a poor prognosis.