유두상 갑상선암종의 측경부 림프절 전이 양상과 경부 청소술에 대한 검토
The Patterns of Lateral Neck Node Involvement in Papillary Thyroid Carcinoma
대한암학회지 1997년 29권 3호 p.466 ~ 472
이두연, 서진학, 신동천,
소속 상세정보
이두연 ( )
연세대학교 의과대학 외과학교실
서진학 ( )
연세대학교 의과대학 외과학교실
신동천 ( )
연세대학교 의과대학 외과학교실
KMID : 0360319970290030466
Abstract
서론
유두상 갑상선암종은 초진시 39∼45%의 경부 림프절 전이 빈도를 보이고 있으나, 다른
두경부 암종과는 달리 고연령층을 제외하고 생존율에 미치는 영향이 크지 않다는 것은 잘
알려져 있다. 현재 경부 청소술은 임상적으로 측정부 림프절 전이가 확인된 예에서만 치료
적인 목적으로 시행되고 있으며, 경부 청소술(comperhensive radical neck dissection)에서
기능 및 미용적인 측면을 고려하여 악하 림프절군(Level Ⅴ)에 임상적인 전이가 없으면
LevelⅡ, Ⅲ, Ⅳ, Ⅴ림프절군만을 제거하는 변형적 광범위 경부 청소술(modified radical neck
dissection)이 주로 시행되고 있다. 최근에는 후경삼각 림프절군(Level Ⅴ)에 임상적인 전이
가 없을 경우는 LevelⅡ, Ⅲ, Ⅳ, 림프절군만을 제거하는 내경정맥 림프절 청소술(jugular
neck dissection)을 시행해도 된다는 주장들이 대두되고 있다.
#초록#
Purpose : We performed this study to identify the patterns of lateral neck node
involvement and to define the appropriate method of neck node dissection in papillary
thyroid
Material and methods : One hundred seventy one patients who had undergone radical
neck dissection for lateral cervical lymph node metastasis of papillary thyroid cancer
from January 1986 to December 1995 were analyzed retrospectively. Total operations
were 178 cases and total radical neck dissections were 206 cases(bilateral in 28 cases,
unilateral in 150 cases). Of these 206 cases, group I(170 cases, 82.5%) who had
undergone comprehensive radical neck dissection or modified radical neck dissection and
group Ⅱ(36 cases, 17.5%) who had undergone jugular neck dissection were studied.
Results : In group 1, the most prevalent site of lymph node metastases was level 111,
followed by level Ⅱ, IV, V and 1. The 158 cases of group I in which nodes in the
posterior triangle of the neck were not palpable preoperatively, were divided into five
groups, 0, 1, 2, 3 and 4 or more, according to the number of clinically positive internal
jugular nodes. The incidence of microscopically positive nodes in level V was
significantly lower in the groups of one or less palpable internal jugular nodes(p=0.0007).
In the 60 of 158 cases with the evaluable CT scans of the neck, the incidence of
microscopically positive nodes in level V was significantly lower in the groups of two
or less positive nodes on CT scan(p=0.0001). And, there were no significant differences
in the incidence of recurrence, sites of recurrence, distant metastases, mortality between
Group I and Group Ⅱ. Conclusion: The modified radical neck dissection might be
justified in most papillary thyroid cancer patients with clinically positive lateral neck
nodes. However, in patients with only one or less palpable node and two or less
positive nodes on CT scan along the jugular lymphatic chains but negative in level V, it
appears to be beneficial to perform a jugular neck dissection in reducing cosmetic
disfigurement and preserving function.
키워드
Papillary thyroid carcinoma; Jugular neck dissection;
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