Lymphknoten-Dissektion des Halses

Der Beitrag stellt die Häufigkeit von Lymphknotenmetastasen bei den histologisch unterschiedlichen Schilddrüsenkarzinomen und deren Einfluss auf die Rezidivwahrscheinlichkeit (RFS) sowie das tumorspezifische Überleben (CSS) der Patienten getrennt voneinander dar. Das technische Vorgehen und die möglichen Komplikationen der zentralen und lateralen Halsdissektion sind dagegen für alle Schilddrüsenkarzinome vergleichbar und werden gemeinsam behandelt.

Kernaussagen

• Die Notwendigkeit und Ausdehnung einer Lymphknotendissektion ist bei malignen Schilddrüsentumoren ohne sichtbare Lymphknotenvergrößerung von deren Histologie, Größe, Multizentrizität und beim medullären Schilddrüsenkarzinom (MTC) von der Höhe des basalen Serum-Calcitonins abhängig

• Die Lage der Lymphknoten im Halsbereich wird anatomisch in spezielle Lymphknotengruppen unterteilt, die jedoch keine klaren Begrenzungen zeigen.

• Die Thyreoidektomie mit zentraler Lymphknotendissektion führt etwa doppelt so häufig zu einem postoperativen Hypoparathyreoidismus wie die alleinige Thyreoidektomie.

• Klinisch wird die Beschreibung der Lokalisation von Lymphknoten im Rahmen einer Operation von Schilddrüsenkarzinomen in 8 unterschiedliche Areale nach Robbins unterteilt, während die Einteilung nach Dralle zwischen Lymphknoten im zentralen und den beiden lateralen Arealen unterscheidet.

• Eine prophylaktische Lymphknotendissektion ist beim papillären Schilddrüsenkarzinom (PTC) für größere Tumoren, für Tumoren mit makroskopischer Infiltration der Schilddrüsenkapsel und für aggressive Varianten des papillären Schilddrüsenkarzinoms gerechtfertigt.

• Die Lymphknotendissektion beim medullären Schilddrüsenkarzinom richtet sich nach der Größe des Tumors, nach klinisch verdächtigen Lymphknoten im Ultraschall, einer möglichen Familiarität mit spezifischer Mutation im RET-Protoonkogen und nach der Höhe des basalen Serum-Calcitonins.

• Die Grenzen des zentralen Lymphknotenkompartments sind lateral durch die A. carotis, kranial durch das Os hyoideum und kaudal durch das Manubrium sterni gegeben.

• Bei Dissektion der lateral gelegenen Lymphknoten des Halses kann deren topografische Lage durch die Einteilung nach Robbins definiert werden

• Abhängig von der Histologie und der Tumorausdehnung kann auch eine regional begrenzte laterale Dissektion sinnvoll sein.

• Patienten sollten vor jeder lateralen Halsdissektion über mögliche Nachblutungen, Ductus-thoracicus-Verletzungen mit Chylusfisteln, ein potenzielles Horner-Syndrom und N.-accessorius-Läsionen aufgeklärt werden.

Schlüsselwörter

Schilddrüsenkarzinom - Halschirurgie - Halslymphknoten - Mediastinum - Thyreoidektomie - Neck Dissection

Publication History

Article published online:
09 February 2026

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