Analysis Of The Initial Treatment Of The Ipsilateral Unilateral Papillary Thyroid Carcinoma Level(Ⅱ-Ⅴ) Lateral Cervical Lymph Nodes Metastasis-related Factors

Objectives:Papillary carcinoma is the most common pathological type in thyroid carcinoma,it has a relatively low degree of malignancy,but the earlier onset of cervical lymph nodes metastasis. Currently,(Ⅱ-Ⅴ) lateral cervical lymph nodes-positive cases of thyroid carcinoma carry out thyroidectomy and functional cervical lymph nodes dissection has no objection, but whether carry out lymph nodes dissection on suspicious level(Ⅱ-Ⅴ) lateral cervical lymph nodes and its sweeping scope is still no consensus, the related risk factors and metastasis regular pattern of this research on unilateral papillary thyroid carcinoma ipsilateral level(Ⅱ-Ⅴ) lateral cervical lymph nodes metastasis is provide the basic for clinical diagnosis and treatment of individualized treatment.Methods:Collecting clinical data of patients in 2011.3~2014.3 period,the First Affiliated Hospital of Dalian Medical University, Department of General Surgery treated with ipsilateral(Ⅱ-Ⅴ) lateral cervical lymph nodes-positive in thyroid carcinoma preoperative or intraoperative, accepted thyroidectomy simultaneously underwent functional cervical dissection, all patients were initial treatment of patients with papillary thyroid carcinoma, retrospective analysis of the clinical features of these patients, including preoperative ultrasonic results, gender, age, whether with the Hashimoto’s thyroiditis, or associated with nodular goiter, neoplastic condition, the maximum diameter of the primary tumor, whether the primary tumor infringe upon the surrounding thyroid envelope, central lymph nodes metastasis and the number of lymph nodes, ipsilateral lateral cervical lymph nodes metastasis and the number of lymph nodes, using statistical methods analyze the risk factors with the lateral cervical lymph nodes-positive, all patients were postoperative follow-up and analysis of postoperative complications about the cases.Results:96 cases of thyroid papillary carcinoma were underwent thyroidectomy simultaneously accepted functional cervical dissection, combined with postoperative pathological results. In 70 cases, cervical lymph nodes metastasis of lateral area of positive patients, the level II lymph nodes metastasis in 36 cases(51.43%), the level III lymph nodes metastasis in 43 cases(61.43%), the level IV lymph nodes metastasis in 50cases(71.43%), the level V lymph nodes metastasis in 14 cases(20%). Chi square test results suggest that the ipsilateral level(Ⅱ-Ⅴ) lateral cervical lymph nodes metastasis associated with the following factors: male, multifocal, the maximum diameter of the primary tumor>1cm, infringing upon the surrounding thyroid envelope, preoperative ultrasonic test suggests lateral cervical lymph nodes metastasis, central lymph nodes metastasis; while age, whether the combined with Hashimoto’s thyroiditis, whether associated with nodular goiter and other factors the has no obvious correlation with level(Ⅱ-Ⅴ) lateral cervical lymph nodes metastasis.Conclusion:1.With cervical nodes metastasis in lymph, the level IV is the most vulnerable to be violated, followed by the level III, the next is the level II, while the level V is not common.2.The rate in males, multifocal tumor, the maximum diameter of the primary tumor>1cm, infringing upon the surrounding thyroid envelope, preoperative ultrasonic suggest lateral cervical lymph nodes metastasis, the central lymph nodes metastasis in the unilateral thyroid papillary carcinoma ipsilateral level(Ⅱ-Ⅴ) lateral cervical lymph nodes metastasis is higher than the control group.3.The central lymph nodes metastasis is the independent risk factors of ipsilateral level(Ⅱ-Ⅴ)lateral cervical lymph nodes metastasis; with the gradual increasing number of positive lymph nodes in level Ⅵ, lateral cervical lymph nodes metastasis positive ratio showed a rising trend. Papillary thyroid carcinoma patients with initial treatment with central lymph nodes dissection, if the central lymph nodes metastasis positive number more than 3, recommending carry out dissection of the level(Ⅱ-Ⅴ) lateral cervical lymph nodes. When without Ⅵ lymph nodes metastasis, in the male,multifocal, the maximum diameter of the primary tumor > 1cm, infringing upon the surrounding thyroid envelope, preoperative ultrasonic test suggests lateral cervical lymph nodes metastasis should be considered for searching the(Ⅱ-Ⅴ) lateral cervical lymph nodes.4.The lateral cervical lymph nodes metastasis of patients, whether it is a single level or more transfer should be regular cleaning the level(Ⅱ-Ⅴ) lateral cervical lymph nodes.