李旭 张艳

摘要：甲状腺癌是常见的内分泌恶性肿瘤，多数呈惰性，淋巴转移是其常见的转移方式，决定肿瘤的临床分期和预后。肿瘤的淋巴转移机制是多年来的研究热点，目前已取得一些成果。本文将从淋巴管分子标志物及在新生肿瘤中的临床应用、淋巴管新生机制及在肿瘤淋巴转移中的作用、淋巴管引流示踪前哨淋巴结及超声在甲状腺癌颈部淋巴结转移中的应用等进行综述，尤其对常规超声、经静脉超声造影、经淋巴超声造影在甲状腺癌颈部淋巴结转移中的应用进行详细描述。

关键词：甲状腺癌；淋巴转移；超声造影

中图分类号： R44  文献标识码： A  文章编号：1000-503X（2024）03-0409-05

DOI：10.3881/j.issn.1000-503X.15694

Progress in Lymphangiogenesis and Lymphatic Metastasis of Thyroid Carcinoma

LI Xu 2，ZHANG Yan 2

1Chinese PLA Medical School，Beijing 100853，China

2Department of Ultrasound，The First Medical Centre of Chinese PLA General Hospital，Beijing 100853，China

Corresponding author：ZHANG Yan Tel：010-6693524 E-mail：zhangyaner301@126.com

ABSTRACT：Thyroid carcinoma is a common endocrine malignancy，with most cases being indolent.Lymphatic metastasis as a representative metastasis type defines the clinical stage and prognosis of thyroid carcinoma.The mechanism of lymphatic metastasis in malignancies has been a research hotspot for years，and certain progress being achieved.This article reviews the molecular markers of lymphatic vessels and their application in diagnosis and treatment of neoplasms，the mechanism and role of lymphangiogenesis in lymphatic metastasis，the tracing methods for sentinel lymph nodes by lymphatic drainage，and the use of ultrasound in cervical lymph node metastasis of thyroid carcinoma.Especially，this paper details the application of conventional ultrasound，transvenous contrast-enhanced ultrasound，and trans-lymphatic contrast-enhanced ultrasound in cervical lymph node metastasis of thyroid carcinoma.

Key words：thyroid carcinoma；lymphatic metastasis；contrast-enhanced ultrasound

Acta Acad Med Sin，2024，46（3）：409-413

甲状腺癌发病率近年来居高不下，且增长速度较快，女性患者中每10万人每年新发甲状腺癌约10.1人，是男性患者的3倍，且每20例女性恶性肿瘤患者中就有1例甲状腺癌患者［1］。甲状腺癌中约90%为乳头状癌（papillary thyroid carcinoma，PTC），早期就可发生淋巴转移，30%～80%的PTC患者在确诊时即存在颈部淋巴结转移，50%～75%的髓样癌患者有中央区淋巴结转移，且当中央区淋巴结转移≥4枚时，同侧颈侧淋巴结转移率可高达98%。颈部淋巴结转移是甲状腺癌患者复发率增高和存活率降低的危险因素，尤其对于中老年患者（＞55岁），淋巴结转移组10年生存率较未转移组下降5%～10%［2］。前哨淋巴结（sentinel lymph node，SLN）作为肿瘤转移最早出现的一个或一组淋巴结，早期反映肿瘤淋巴引流区域的情况。国际和国内均建议对在术前或术中检查时已证实有颈侧区淋巴结转移的患者行颈侧区淋巴结清扫，但并不主张进行预防性清扫［3-4］。……