| Objective: Papillary thyroid carcinoma is the most common malignant tumor caused by thyroid follicular cells.It is the most common pathological tissue type of thyroid malignant tumors.It has biological characteristics of slower growth and better prognosis.Papillary thyroid carcinoma is an inert disease,but it often metastasizes to regional lymph nodes.And the residual metastatic lymph nodes in the neck are the most common cause of the tumor recurrence.In the central region lymph nodes,adipose tissue,including lymph nodes,can exist not only in front of the recurrent laryngeal nerve,but also on the posterior of the recurrent laryngeal nerve.The reason of posterior lymph nodes of the recurrent laryngeal nerve exist only on the right is that,in anatomy,the right recurrent laryngeal nerve rises through the adipose tissue in the right compartment while the left recurrent laryngeal nerve fits tightly between the esophagus and the trachea.This anatomical difference causes a large amount of adipose tissue which including lymph nodes to exist behind the right recurrent laryngeal nerve.These lymph nodes are located between the right recurrent laryngeal nerve,the esophagus,and the posterior side of the anterior vertebral fascia,and those are called the right recurrent laryngeal nerve posterior lymph nodes.Some foreign literatures also refer to the right paraesophageal lymph nodes.Due to the deeper anatomical location of the lymph nodes of right recurrent laryngeal nerve,the lymph nodes are often ignored or dislocated in the process of in the central area lymph node dissection,which may result in missed lymph nodes and lead to secondary surgery in the patient,which increases the intraoperative and the risk of postoperative complications.In addition,the missing lymph node usually revolves around the entire recurrent laryngeal nerve after recurrence,causing the patient tohoarse.At that time,the patient seeks medical treatment again,and can only disconnect the recurrent laryngeal nerve,which is quite harmful.This article collects clinical data of patients with dorsal lymph node metastasis to the recurrent laryngeal nerve of papillary thyroid carcinoma,extracts the clinical risk factors from it for retrospective statistical analysis,and then looks for the risk factors that cause lymph node metastasis in the right VIb area,so as to achieve the purpose of screening high-risk groups Provide accurate treatment plan for each patient.Methods: A total of 609 patients with PTC who underwent surgical treatment at the Second Department of Thyroid and Breast of Zhongshan Hospital of Dalian University from January 2016 to December 2019 were retrospectively analyzed,and a total of 323 studies were included according to the inclusion criteria.Inclusion criteria:All patients were diagnosed by preoperative fine needle aspiration or intraoperative frozen pathology.Excluding simple left lobe and isthmus thyroid cancer.All patients were injected with a nano-carbon suspension inside the thyroid for negative parathyroid imaging and lymph node tracing during the operation.At the same time,the recurrent laryngeal nerve monitor was used to find and protect the recurrent laryngeal nerve.Based on the postoperative paraffin pathological results,patients were divided into two groups based on the presence or absence of central node lymph node metastasis,and data were collected.Lymph nodes in the right central region were further divided into VIa(superficial layer of right central cervical region)lymph nodes and VIb(right dorsal recurrent laryngeal nerve)lymph nodes.The univariate and multivariate regressions were used to analyze the risk factors of lymph node metastasis in VIa and VIb area.The clinical risk factors of lymph node metastasis in VIa and VIb areas were obtained,and the regularity of lymph node metastasis in VIb area was discussed.Results: The metastasis rate of the posterior lymph nodes in the right recurrent laryngeal nerve was 14.9%,and the rate of lymph node metastases in the right central region was 36.02%.At the same time,the posterior lymph node metastases in the central region and the right recurrent laryngeal nerve were 14.2%.Univariate analysis of lymph nodes in the central area and clinically relevant factors showed that younger than55 years of age,tumor diameter,and extra-glandular tumor invasion were independent risk factors for lymph node metastasis in the right region VI(P<0.05);multivariate regression analysis showed that the age was less than 55 years old,tumor diameter and extra-glandular tumor invasion were independently associated with lymph node metastasis in the right region VI(P<0.05).Univariate analysis of the posterior lymph nodes of the right recurrent laryngeal nerve and clinically relevant factors showed that male,tumor diameter,extra glandular invasion,and positive lymph nodes in the central area were associated with posterior lymph node metastasis of the right recurrent laryngeal nerve(P <0.05);multiple factors regression analysis showed that men,tumor diameter,extra-glandular invasion,and positive lymph nodes in the right region VI were independent risk factors for posterior lymph node metastasis in the right recurrent laryngeal nerve.The R0 C curve shows: when the right VIA area lymph node metastasis,extra-glandular invasion,and right cancerous area> 0.85 cm were used to predict the right recurrent laryngeal nerve posterior lymph node metastasis,the Auc values were 0.713,0.851,0.639(P <0.001).Conclusion: For patients with stage cN0 papillary thyroid carcinoma,lymph node metastasis to the LN-pr RLN should not be overlooked during central lymph node dissection.When the patient was male,the tumor diameter was greater than 0.85 cm,extra-glandular invasion,and the lymph node metastasis in the right central region,the LN-pr RLN should be routinely dissected,and the thoroughness of the dissection should be emphasized,even at the time of preoperative evaluation or intraoperative exploration,there was no clear evidence of metastasis. |
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