分化型甲状腺癌侧颈部淋巴结转移特点及诊疗技术研究进展

doi:10.3760/cma.j.cn101202-20200525-00171

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摘要目的总结分化型甲状腺癌(DTC)侧颈部淋巴结转移的特点及诊疗技术研究进展。方法以“分化型甲状腺癌”“颈部淋巴结转移”“侧颈淋巴结转移”“颈淋巴结清扫术”“侧颈淋巴结清扫术”“differentiated thyroid cancer”“cervical lymph node metastasis”“lateral cervical lymph node metastasis”“neck dissection”“lateral neck dissection”等为中、英文关键词,在中国知网、万方数据库、PubMed等中、英文数据库中,检索2019年12月之前发表的有关DTC侧颈淋巴结转移特点及其诊疗技术研究进展方面的文献2 084篇,排除无法获取全文、内容不符、重复性及低质量的文献,最终纳入39篇文献,进行分析和总结。结果侧颈部淋巴结转移在DTC中并不少见,其中Ⅲ、Ⅳ区转移最常见,Ⅰ、Ⅱ、Ⅴ区相对少见。影像学诊断首选颈部超声检查,术前定性诊断有赖于穿刺活检的病理组织学诊断结果。手术作为首选治疗方案正趋于精细化,对cN1b DTC患者行治疗性侧颈部淋巴结清扫术已基本达成共识。化疗、放疗及生物治疗等仅作为晚期患者的辅助治疗方案。结论术前全面评估,术中精准定位,手术根治性切除,恰当地综合治疗是目前针对DTC患者发生侧颈部淋巴结转移时的最佳诊疗策略。

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	徐萌
	王晓雷

关键词 ：甲状腺肿瘤, 分化型甲状腺癌, 淋巴转移, 颈淋巴结清扫术

Abstract：Objective This work aims to summarize the characteristics and progress of the diagnosis and treatment of lateral cervical lymph node metastasis in differentiated thyroid cancer (DTC).Methods “分化型甲状腺癌”“淋巴结转移”“侧颈淋巴结转移”“颈淋巴结清扫术”“侧颈淋巴结清扫术”“differentiated thyroid cancer” “cervical lymph node metastasis” “lateral cervical lymph node metastasis” “neck dissection” and “lateral neck dissection” were used as keywords to identify articles about differentiated thyroid carcinoma with lateral cervical lymph node metastasis, as well as its progress of diagnosis and treatment. The articles searched included those published before December 2019 in CNKI, Wanfang, and PubMed. A total of 2 084 articles were retrieved, among which 39 were included after excluding those with inaccessible full text, inconsistent content, redundant topics, and low-quality literatures.Results Lateral cervical lymph node metastasis is common in DTC; the most common metastasis is in levels Ⅲ and Ⅳ, and relatively rare ones are in levels Ⅰ, Ⅱ, and Ⅴ. Ultrasound is the preferred choice for imaging diagnosis, and enhanced CT and MRI are used as supplementary examinations. Preoperative qualitative diagnosis depends on fine-needle aspiration biopsy. In recent years, surgery as the preferred choice of treatment has been refined. At present, for patients with DTC (cN1b), therapeutic lateral neck dissection has basically reached a consensus. Chemotherapy, radiotherapy, and biotherapy are used as adjuvant treatment for advanced patients.Conclusions Comprehensive preoperative evaluation, accurate intraoperative location, appropriate dissection, and adjuvant treatment are the optimal strategies for patients with lateral cervical lymph node metastasis in DTC.

Key words： Thyroid neoplasms Differentiated thyroid carcinoma Lymphatic metastasis Neck dissection

收稿日期: 2020-05-25

通讯作者: 王晓雷,Email:wangxlcams@126.com

引用本文:

徐萌, 王晓雷. 分化型甲状腺癌侧颈部淋巴结转移特点及诊疗技术研究进展[J]. 中华解剖与临床杂志, 2021, 26(3): 362-367.
Xu Meng, Wang Xiaolei. Characteristics, diagnosis, and treatment of lateral cervical lymph node metastasis in differentiated thyroid cancer. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 362-367.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200525-00171 或 http://www.cjac.com.cn/CN/Y2021/V26/I3/362

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