摘要
目的探讨甲状腺微小乳头状癌（PTMC）中央区淋巴结转移（CLNM）的相关危险因素及中央区淋巴结清扫术（CLND）的应用价值。方法选取251例经病理活检确诊的甲状腺微小乳头状癌患者为研究对象,根据其淋巴结转移情况分成转移组（n=42）和非转移组（n=209）。回顾性分析2组患者一般资料,对单因素分析后存在显著性差异的指标行非条件Logistic回归分析。淋巴结转移患者予以中央区淋巴结清扫术后,随访1~3年,记录其术后相关并发症发生率及复发率。结果 2组患者在肿瘤位置、合并腺瘤、桥本甲状腺炎、结节性甲状腺肿、甲亢等因素对比差异无统计学意义（P〉0.05）。转移组患者中年龄小于45岁者及男性比例均显著高于非转移组,差异具有统计学意义（P〈0.05）。转移组患者中肿瘤直径为5~10 mm者25例（59.5%）,多灶12例（28.6%）,突破被膜22例（52.4%）,未转移组相应的数据为70例（33.5%）、23例（11.0%）和67例（32.1%）,均显著低于转移组,差异具有统计学意义（P〈0.05）。转移组患者术后嘶哑1例（2.3%）,局部麻木6例（14.3%）,神经侵犯1例（2.3%）,脉管侵犯2例（4.8%）,无咳呛报告;随访1~3年中,仅2例复发,复发率为4.8%。非转移组术后则无以上并发症,也无复发。结论甲状腺微小乳头状癌患者发生中央区淋巴结转移多为年龄小于45岁的男性,存在肿瘤直径超过5 mm、多灶性病变、伴有被膜突破症状等特点,临床需将满足上述条件者列为重点关注对象并予以相关防预措施,以降低中央区淋巴结转移发生风险。对甲状腺微小乳头状癌患者予以中央区淋巴结清扫术治疗,疗效确切,可有效改善其预后质量。
Objective To explore the related risk factors of central lymph node metastasis（ CLNM） of papillary thyroid microcarcinoma（ PTMC） and the application value of central lymph node dissection（ CLND）. Methods Totally 251 patients who were confirmed as PTMC by pathological biopsy were selected as the research object,and they were divided into the metastasis group（ n = 42） and the non-metastasis group（ n = 209） according to the status of lymph node metastasis. The general datum of the two groups were retrospectively analyzed,and the indexes with significant differences after univariate analysis were analyzed by non-conditional Logistic regression analysis. Treated the patients with lymph node metastasis through CLND,and the occurrence rate and recurrence rate of related complications were recorded during the 1 to3 years of follow-up. Results The comparison of the location of the tumor,complicated adenoma,Hashimoto＇s thyroiditis,nodular goiter,and hyperthyroidism between the two groups was not statistically significant（ P〈0. 05）. In the metastasis group,the rate of patients aged less than 45 years old and the percentage of male patients were both significantly higher than the non-metastasis group,and the difference was of statistical significance（ P〈0. 05）. There were 25 cases（ 59. 5%） whose tumor diameter were 5 ~ 10 mm,12 cases（ 28. 6%） with multiple lesions,and 22 cases（ 52. 4%） breaking through the envelope in the metastasis group,which were significantly higher than 70 cases（ 33. 5%）,23 cases（ 11. 0%） and 67 cases（ 32. 1%） in the non-metastasis group,and the differences were statistically significant（ P〈0. 05）. In the metastasis group after operation,there was 1 cases（ 2. 3%） of hoarseness,6 cases（ 14. 3%） of local numbness,1 case（ 2. 3%） of nerve invasion,and 2 cases（ 4. 8%） of vascular invasion,and there was no choking cough report. During the period of 1 to3 years of follow-up,there were only 2 cases of recurrence and the recurrence rate was 4. 8%. Conclusion Central lymph node metastasis mostly occurs in the male patients with PTMC who are less than 45 years old. And the main characteristics are diameter of tumor over 5 mm,multifocal lesions,with envelope penetration symptom and so on. In clinic,patients who meet the above-mentioned condition should be taken as the primary concern and given related prevention measures to reduce the occurrence risk of central lymph node metastasis. To treat patients with papillary thyroid microcarcinoma through central lymph node dissection can receive good curative effect and effectively improve the prognosis quality,and it is worthy of clinical promotion.
出处
《局解手术学杂志》
2016年第1期38-41,共4页
Journal of Regional Anatomy and Operative Surgery
基金
南京大学医学院附属鼓楼医院院级课题(ZSB833)
关键词
甲状腺微小乳头状癌
中央区
淋巴结转移
淋巴结清扫术
临床特点
危险因素
papillary thyroid microcarcinoma
central zone
lymph node metastasis
lymph node dissection
clinical characteristics
risk factors
