甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析
| 作者: |
1翟宝伟,
1高庆军,
2赵代伟
1 贵州医科大学附属医院 甲状腺外科，贵州 贵阳 550004 2 贵州医科大学第二附属医院 甲状腺外科，贵州 凯里 556000 |
| 通讯: |
赵代伟
Email: zhaodw@hotmail.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2016.11.009 |
摘要
目的：探讨甲状腺微小乳头状癌（PTMC）颈部淋巴结转移的危险因素。方法：回顾性分析贵州医科大学附属医院甲状腺外科2014年1月—2016年3月收治的169例PTMC患者临床病理资料。结果：169例患者均行预防性中央区淋巴结清扫，其中54例（32.0%）发生中央区淋巴结转移，单因素分析发现中央区淋巴结转移与年龄<45岁、多灶性肿瘤、侵出包膜有关（均P<0.05），多因素分析显示，年龄、多灶性肿瘤、侵出包膜都是中央区淋巴结转移的独立危险因素（均P<0.05）。30例行中央区淋巴结加侧颈区淋巴结清扫，其中18例（10.7%）发生侧颈区淋巴结转移，单因素分析显示，肿瘤最大径、侵出包膜、多灶性肿瘤、中央区淋巴结转移与侧颈区淋巴结转移有关（均P<0.05），多因素分析显示，肿瘤侵出包膜为侧颈区淋巴结转移的高危因素（P<0.05）；11例（6.5%）发生中央区并侧颈区淋巴结转移，侵出包膜、多灶性肿瘤为中央区并侧颈区淋巴结共同发生转移的高危因素（均P<0.05）。高分辨率颈部淋巴结B超对中央区淋巴结转移的灵敏度、特异度分别为14.8%、96.5%，其对侧颈区淋巴结转移的灵敏度、特异度分别为94.4%、83.3%。结论：年龄<45岁、多灶性肿瘤、侵出包膜是PTMC颈部淋巴结转移的危险因素。高分辨率颈部淋巴结B超可以作为甲状腺癌颈部淋巴结转移术前评估的重要手段。
关键词：
甲状腺肿瘤
淋巴转移
颈淋巴结清扫术
危险因素
Analysis of risk factors for cervical lymph node metastases in papillary thyroid microcarcinoma
CorrespondingAuthor:ZHAO Daiwei Email: zhaodw@hotmail.com
Abstract
Objective: To investigate the risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC). Methods: The clinicopathologic data of 169 patients with PTMC treated in the Department of Thyroid Surgery of Affiliated Hospital of Guiyang Medical University from January 2014 to March 2016 were retrospectively analyzed. Results: All the 169 patients underwent prophylactic central neck dissection, of whom 54 cases (32.0%) had central lymph node metastases; univariate analysis showed that age greater than 45 years old, multiple lesions and extrathyroidal invasions were related to central cervical lymph node metastases and multivariate analysis identified that age, multiple lesions and extrathyroidal invasion were independent risk factors for central lymph nodes metastasis (all P<0.05). Thirty patients received central and lateral neck dissection and of them, 18 cases (10.7%) had lateral lymph node metastases (18/30); univariate analysis demonstrated that the maximal diameter of the tumor, extrathyroidal invasion, multiple lesions and central lymph node metastases were associated with lateral lymph node metastases, and multivariate analysis indicated that only extrathyroidal invasion was a dependent risk factor for lateral lymph node metastases (P<0.05); 11 of the 30 cases (6.5%) had both central and lateral lymph node metastases, and both univariate and multivariate analyses found that multiple lesions and extrathyroidal invasion were risk factors for concomitant central and lateral lymph node metastases (all P<0.05). The sensitivity and specificity of high frequency color Doppler ultrasonography for detection of central lymph nodes metastasis was 14.8% and 96.5%, for detection of lateral lymph nodes metastasis was 94.4% and 83.3%, respectively. Conclusion: Age greater than 45 years, multiple lesions and extrathyroidal invasion are risk factors for PTMC cervical lymph node metastasis. High frequency neck ultrasound examination can be used as a preoperative assessment approach of PTMC lymph node metastases.
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