| Objective: To analysis the incidence and risk factors for posterior to right recurrent laryngeal nerve lymph node metastasis in papillary thyroid carcinomaMethods: A retrospective analysis of clinical data of 30 patients with primary PTC information from the second hospital affiliated to suzhou university general surgery, all the operations were finished by the same treatment team between January 2014 and January 2016,who are confirmed by the intraoperative and postoperative pathologic diagnosis. The central lymph nodes of 30 patients are divided into two subregions with laryngeal recurrent nerve, We named the right CLN anterior to the right recurrent laryngealn nerve(RLN) Level VI A lymph nodes and posterior to RLN Level VI B lymph nodes. To analysis the correlation of lymph node metastasis with patients’ age, sex, tumor diameter, multifocal or not, the capsule invasion, VI A lymph node metastasis.Results: All of the 32 patients, 20 patients with lymph node metastasis and the rate is 62.5%.In the operation the surgeon dissect 280 lymph nodes which are from the central compartment.Of all the lymph nodes 71 were proved metastatic, the rate is 25.35%.In 20 patients with lymph node metastasis, each subregion lymph node metastasis, VI area A lymph nodes(19/20), lymph nodes only VI area B(1/20). 11 cases of patients VIA and VIB lymph nodes were all with metastasis, accounting for 55%. Skip Metastasis(VIA the area without lymph node metastasis, VI B area with lymph node metastasis) were found in 1 case. The factors of posterior to right recurrent laryngeal nerve lymph node metastasis include multiple lesions(OR = 4.762, 95% CI 1.06 ~ 4.97, P = 0.019) and invaded by membranes(OR = 3.21, 95% C, 1.80-- 4.15, P = 0.037). Before the laryngeal recurrent nerve lymph nodes(OR = 2.12, 95% CI 0.5 ~ 4.60, P = 0.013)Conclusion: Patients with thyroid papillary carcinoma increased the probability of the incidence of the central lymph node metastasis, the Level A lymph node metastasis is most common.The patients whose tumor invaded maximum diameter > 1 cm, capsule, multiple lesions, VI area lymph node lymph node metastasis should accept Centralcompartment lymph nodes dissection. The scope of the CLND should include Level VI A and Level VI B. Most of the postoperative parathyroid and laryngeal recurrent nerve injury is temporary, we can induce the incidence through improve the level of operation. |
