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[目的]探讨甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)患者中央区阴性淋巴结清扫的理论依据及应用策略。[方法]回顾性分析294例PTC初治患者术中阴性淋巴结清扫情况,按照有无合并HT分为合并组(A组)和单纯组(B组)。比较两组病理特征对术中阴性淋巴结清扫的影响。[结果]中央区淋巴结转移发生率A组低于B组(43.8%vs 62.4%,P=0.040),淋巴结清扫总数A组多于B组(9.14±2.37 vs 6.75±0.97,P<0.001),阴性淋巴结清扫数A组多于B组(6.56±0.41 vs 2.83±0.47,P=0.002)。颈淋巴结术后病理阳性率A组低于B组(53.39%vs 63.11%,P=0.012)。手术时间A组高于B组(82.22 min vs 70.32 min),手术出血量A组多于B组(37.53±2.47ml vs 22.46±1.31ml,P=0.040)。[结论 ]认识PTC合并HT患者中央区淋巴结转移特点,合理控制中央区阴性淋巴结清扫数目及范围,可有效降低术后并发症。
[Objective] To explore the theoretical basis and application strategies of central lymph node dissection in patients with thyroid papillary carcinoma (PTC) complicated with Hashimoto’s thyroiditis (HT). [Methods] The negative lymph node dissection in 294 PTC patients undergoing primary resection was retrospectively analyzed. The patients were divided into combined group (A group) and simple group (B group) according to the presence or absence of combined HT. The effects of pathological features of the two groups on the operation of negative lymph node dissection were compared. [Results] The incidence of lymph node metastasis in the central area was lower in group A than in group B (43.8% vs 62.4%, P = 0.040). The total number of lymph node dissections in group A was more than that in group B (9.14 ± 2.37 vs 6.75 ± 0.97, P <0.001) The number of negative lymph node dissection was more in group A than in group B (6.56 ± 0.41 vs 2.83 ± 0.47, P = 0.002). The pathological positive rate of cervical lymph node in group A was lower than that in group B (53.39% vs 63.11%, P = 0.012). The operative time in group A was higher than that in group B (82.22 min vs 70.32 min). The bleeding in group A was more than that in group B (37.53 ± 2.47ml vs 22.46 ± 1.31ml, P = 0.040). [Conclusions] Knowing the characteristics of lymph node metastasis in the central area of patients with PTC combined with HT and rationally controlling the number and range of negative lymph nodes in the central area can effectively reduce postoperative complications.