甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析  

Metastatic Pattern and Influencing Factors of Cervical Lymph Node in Papillary Thyroid Carcinoma

作　　者：高庆军[1] 王南鹏[1] 周彦[1] 段海松[1] 高荣君[1] 赵代伟[1] 龚卫东[1] 黄堃[1] 

机构地区：[1]贵阳医学院附属医院甲状腺外科,贵州贵阳550004

出　　处：《中国普外基础与临床杂志》2013年第3期303-309,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结的转移规律及其影响因素,为PTC颈部淋巴结清扫手术方式的选择提供依据。方法收集贵阳医学院附属医院甲状腺外科2009年1月至2011年12月期间收治的98例PTC患者的临床资料,对其淋巴结转移特点、规律及其影响因素进行回顾性分析。结果 98例患者中,共行颈部淋巴结清扫114侧。总颈淋巴结转移率为77.55%(76/98),其中Ⅵ区淋巴结转移率为74.49%(73/98),颈侧Ⅱ+Ⅲ+Ⅳ区为42.86%(42/98),Ⅴ区为5.10%(5/98)。单因素分析结果显示:当肿瘤直径大于1 cm、侵犯甲状腺包膜、呈多灶性或年龄大于45岁时,Ⅵ区和Ⅱ+Ⅲ+Ⅳ区的淋巴结转移率较高(P<0.05)。多因素分析结果显示:患者年龄、肿瘤直径、包膜侵犯及多灶性是颈部淋巴结转移的影响因素(P<0.05);包膜侵犯、多灶性、合并Ⅵ区淋巴结转移及合并颈侧Ⅱ+Ⅲ+Ⅳ区淋巴结转移是喉前淋巴结转移的影响因素(P<0.05);包膜侵犯和多灶性是跳跃性淋巴结转移的影响因素(P<0.05)。结论 PTC易发生Ⅵ、Ⅲ及Ⅳ区淋巴结转移,应常规清扫Ⅵ区淋巴结。对颈部淋巴结转移规律的研究可为临床选择合理的颈部淋巴结清扫手术方式提供依据。Objective To explore the pattern and clinical influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma（PTC）,and provide a basis for the choice of surgical approach for the PTC neck lymph node processing.Methods The clinical data of 98 patients with PTC treated in Affiliated Hospital of Guiyang Medical College from Jan.2009 to Dec.2011 were collected,and the pattern and clinical influencing factors of cervical lymph node metastasis were analyzed.Results Ninety eight consecutive patients underwent neck dissection in a total of 114 sides.The lymph node metastasis rate of cervical lymph node,districtⅥ,districtⅡ＋Ⅲ＋Ⅳ,and districtⅤwas 77.55%（76/98）,74.49%（73/98）,42.86%（42/98）,and 5.10%（5/98）,respectively.Results of univariate analysis showed that lymph node metastasis rates were higher in patients with diameter of tumor greater than 1 cm,tumor invaded thyroid capsule,multifocal tumor,and old than 45 years（P0.05）.Results of multivariate analysis showed that the age of patients,diameter of tumor,tumor invaded thyroid capsule,and multifocal tumor were independent risk factors of cervical lymph node metastasis（P0.05）.Tumor invaded thyroid capsule,multifocal tumor,combined with districtⅥmetastasis,and combined with districtⅡ＋Ⅲ＋Ⅳ metastasis were independent risk factors of prelaryngeal lymph node metastasis（P0.05）. Tumor invaded thyroid capsule and multifocal tumor were independent risk factors of skip lymph node metastasis（P 0.05）.Conclusions DistrictⅥ is found to be the predominant site for lymph node metastasis of PTC,the districtⅢ and the districtⅣinvolved in addition,so it is necessary to clean lymph nodes at districtⅥ routinely.The regularity of cervical lymph node metastasis can provide the basis for surgeon to choose a reasonable type of neck dissection.

关 键 词：甲状腺乳头状癌 颈淋巴结清扫术 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]