Surgical Clinical Study For Clinical Stage N0 Differentiated Thyroid Carcinoma Of The Upper Pole

Objective : To analyze the cervical lymph node metastasis in clinical stage N0 differentiated thyroid carcinoma of the upper pole.To explore the risk of cervical node metastasis in clinical stage N0 differentiated thyroid carcinoma.Select the appropriate way to expose the external branch of the superior laryngeal nerve and generalize its classification,and provide reference for clinical practice to guide clinical practice.Methods:Totally 72 cases of c N0 differentiated thyroid carcinoma who underwent Thyroidectomy the affected side central compartment lymph node dissection in the first group of our ward from January 2017 to October 2017 were enrolled in the study.They both chose to use Carbon Nanoparticles Suspension Injection and routinely expose the external branch of the superior laryngeal nerve.They were divided into two groups according to the tumor location,upper group(tumor in the upper pole,24cases),Non-upper group(tumor not in the upper pole,48cases).The number of lymph node metastases in the Inferior horns of thyroid cartilage,tumor diameter,central lymph node metastasis cases,and the the distribution of transverse blood vessel,the external branch of the superior laryngeal nerve were all collected.Totally 40 cases of c N0 differentiated thyroid carcinoma who Non-exposed external superior laryngeal nerve in the second group of our ward from January 2017 to October 2017 were used as a control to compare the postoperative functional status of the external branch of the superior laryngeal nerve.Result:There were 95 cases of transverse blood vessel in front of the external branch of the superior laryngeal nerve.4 cases it above the external branch of the superior laryngeal nerve,16 cases the external branches of the superior laryngeal nerve and transverse blood vessel were accompanied and 75 cases it below the external branch of the superior laryngeal nerve.For the number of transverse blood vessels,,one of 38 cases,2 of 50 cases,and 3 of 7 cases.The relationship between the external branch of superior laryngeal nerve and the superior thyroid artery was studied in 105 cases.Among them,82 cases were located on the medial side of superior thyroid artery;18 cases were located on the lateral side of superior thyroid artery and 5 cases were located between the branches of superior thyroid artery.According to the Cernea classification,there were 63 cases of type 1,24 cases of type 2A,and 13 cases of type 2B,and 5 cases were not identified.The VHI-10 score was used to evaluate the functional status of the external branch of the superior laryngeal nerve.Analysis revealed that there was a difference in the postoperative VHI-10 score between the exposed and non-exposed groups(p<0.05).There was no significant difference in the number of lymph node metastasis and the number of lymph node metastasis between the upper group and the non-upper group in the lower corner of the thyroid cartilage(p>0.05).There was no significant difference in the number of lymph node staining black and the number of lymph node metastasis between the upper group and the non-upper group in the Inferior horns of thyroid cartilage(p>0.05).There was a statistically significant difference in lymph node metastasis(prelaryngeal lymph node and right recurrent laryngeal nerve lymph node)between the upper group and the non-upper group(p<0.05).Univariate analysis of central cervical lymph node metastases revealed a statistically significant difference in tumor diameter,tumor location,and invaded thyroid capsule(p<0.05).Logistic regression analysis showed that tumor diameter(OR=6.485,P=0.003)and invaded thyroid capsule(OR=11.953,P=0.000)were independent factors influencing lymph node metastasis in the central region.Conclusion:1.The gap can be used as an important anatomical landmark to reveal the lateral branch of the superior laryngeal nerve during surgery.Exposure of the external branch of the superior laryngeal nerve from this gap approach can effectively prevent its intraoperative damage.2.When the tumor is located at the upper pole,if there is no black-stained lymph node in the Inferior horns of thyroid cartilage during operation,the fat tissue of this area can be retained,thereby reducing probability of anatomical damage.At the same time,more attention should be paid to the prelaryngeal lymph node.3.Tumor diameter(OR=6.485,P=0.003)and invaded thyroid capsule(OR=11.953,P=0.000)were risk factors for lymph node metastasis in the central region.