Study On The Regularity Of Lateral Neck Lymph Node Metastasis In Reoperation Of Papillary Thyroid Carcinoma

Objective:To analyze the lateral neck lymph node metastasis of papillary thyroid carcinoma after reoperation,and to explore the influencing factors of lateral neck lymph node metastasis in patients with reoperation,to formulate individualized treatment plans,and to guide the lateral neck metastasis during reoperation of papillary thyroid carcinoma(PTC).Reasonable dissection of lymph nodes in order to obtain more thorough treatment and better prognosis.Methods:From February 2012 to August 2022,229 patients with PTC combined with lateral cervical lymph node dissection who underwent reoperation in the Department of Thyroid Surgery,China-Japan Union Hospital of Jilin University were selected.All patients underwent reoperation and lateral cervical lymph node dissection.The lymph nodes of each level were sent for pathological examination.The basic information of all 229 patients,preoperative serological examination,color Doppler ultrasound examination and paraffin pathology and other related clinical case data were collected.The metastasis of lateral neck levels in patients undergoing reoperation was counted,and the metastasis rules and risk factors of lateral neck levels in patients undergoing reoperation were analyzed.Results:Among the 229 patients in this study,the ratio of male to female was 1:3.09(56:173),the average age of the first operation was 37.64 years old(12-70 years old),and the average BMI index was 24.2kg/m~2(16.82-52.73 kg/m~2).The average interval between the first operation and this operation was 41.77 months(0.3-353months).Among them,74 patients(32.31%)underwent reoperation within 1 year after the first operation,and 178 patients(77.73%)underwent reoperation within 5 years after the first operation.1.Patients were grouped according to whether cervical lymph node dissection was performed in the first operation,and statistics were made respectively.The number and rate of lymph node metastasis in each region of the lateral neck.Among the 149 patients who did not undergo cervical lymph node dissection in the first operation,the lymph node metastasis rate in level Ⅳ was highest,the metastasis rate was 49.66%,followed by level Ⅲ,the metastasis rate was 46.31%,and the metastasis rate in level Ⅱ was the lowest,31.54%.Among the patients who had undergone cervical lymph node dissection in the first operation,the lymph node metastasis rate of level Ⅱ was the highest(51.25%),followed by level Ⅲ(42.5%)and level Ⅳ(36.25%).2.Analysis of the factors related to lymph node metastasis in each area of the lateral neck showed that lymph node metastasis in the level Ⅳ of patients who did not undergo lateral neck lymph node dissection for the first time was related to the invasion of the tumor(P<0.05).3.In patients who had lateral lymph node dissection in the first operation,the lymph node metastasis of level Ⅲ in the second operation was related to gender.Compared with female patients,male patients were more likely to have level Ⅲ lymph node metastasis in the second neck dissection(P=0.043).Conclusion:1.The rate of lymph node metastasis in levels Ⅲ and Ⅳ was higher in patients who did not undergo lateral neck dissection for the first time,and the rate of lymph node metastasis in level Ⅱ was the highest in patients who underwent lateral neck dissection again.2.Level Ⅳ lymph node metastasis in patients who did not undergo lateral cervical lymph node dissection for the first time was associated with external invasion of the tumor.3.For men who have undergone lateral neck lymph node dissection in the first operation,attention should be paid to the dissection of level Ⅲ in the second operation.