Abstract：
Cervical lymph node metastasis is frequent in patients with papillary thyroid carcinoma. In addition to the extent of thyroidectomy, the need as well as the extent of concomitant lymphadenectomy has been a subject of controversy and debate. The central compartment is the most frequent site of metastasis followed by the lateral compartment although skip metastasis in the lateral compartment can occur. Papillary thyroid carcinoma can also present with cervical lymph node metastasis, while the primary tumor remains clinically undetectable. Surgical removal of clinically involved nodal metastasis should be mandatory to prevent recurrence and improve disease prognosis. However, despite a low accuracy of preoperative imaging for microscopic disease and the frequent microscopic metastasis to the central compartment, routine prophylactic neck dissection has not been shown to have any relevance to prevent recurrence or improve disease cure. Routine or prophylactic central compartment dissection is generally not recommended unless in the presence of high-risk tumors. The potential benefit of reducing central compartment recurrence or avoiding high-risk reoperation probably outweighs the risk of inducing surgical complication including hypoparathyroidism during routine central neck dissection. Therapeutic lateral neck dissection is performed for clinically involved nodes detected by preoperative imaging confirmed by needle biopsy, while prophylactic lateral neck dissection is contraindicated. The extent of neck dissection has been de-escalated, and compartmental nodal dissection aiming at preservation of function is performed to achieve a complete surgical resection. Postoperative adjuvant radioiodine is frequently administered for patients with positive nodal metastasis (intermediate-risk group) to avoid future recurrence. Routine central neck dissection may also upstage patients with microscopic nodal metastases and increase the use of postoperative adjuvant radioiodine.
摘要：
甲状腺乳头状癌患者经常发生颈淋巴结转移。除了甲状腺切除术的范围，同时行淋巴结清扫术的必要性和范围一直是争议和争论的话题.中央区室是最常见的转移部位，其次是外侧区室，尽管外侧区室可能发生跳跃转移。甲状腺乳头状癌也可表现为颈淋巴结转移，而原发性肿瘤在临床上仍无法检测到。必须手术切除临床上涉及的淋巴结转移，以防止复发并改善疾病预后。然而,尽管术前成像的准确性较低的微观疾病和频繁的微观转移到中央室，常规预防性颈淋巴结清扫术未显示与预防复发或改善疾病治愈有任何相关性.除非存在高危肿瘤，否则通常不建议进行常规或预防性中央隔室解剖。减少中央间室复发或避免高风险再次手术的潜在益处可能超过在常规中央颈清扫术中诱发包括甲状旁腺功能减退症在内的手术并发症的风险。对经穿刺活检证实的术前影像学检测到的临床涉及的淋巴结进行治疗性侧颈淋巴结清扫术。而预防性侧颈清扫是禁忌的。颈部夹层的范围已经降级,并进行旨在保留功能的房室淋巴结清扫，以实现完整的手术切除。术后辅助放射性碘经常用于淋巴结转移阳性的患者（中危组），以避免将来复发。常规中央颈淋巴结清扫术也可能使显微镜下淋巴结转移的患者更上一层楼，并增加术后辅助放射性碘的使用。
