分化型甲状腺癌颈部淋巴结转移相关因素分析  

Risk factors of cervical lymph node metastasis in differentiated thyroid carcinoma

作　　者：郑雅娟[1] 袁宏钧[1] 仲妙春[1] 吕振晔[1] 张静霞[1] 姜蔚[1] 

机构地区：[1]浙江省人民医院甲状腺乳腺外科,杭州310014

出　　处：《浙江医学》2013年第5期361-363,共3页Zhejiang Medical Journal

摘　　要：目的探讨分化型甲状腺癌颈部淋巴结转移的相关因素和合理的手术方式。方法对近8年来手术治疗的616例分化型甲状腺癌患者的临床及病理资料进行统计分析，比较不同年龄、性别、多灶性情况、肿瘤是否侵犯包膜、肿瘤直径及病理特征的患者颈部淋巴结转移发生率，寻找发生颈淋巴结转移的危险因素。结果术后病理检查诊断为甲状腺乳头状癌566例，滤泡状癌50例。所有患者中，中央区（VI区）淋巴结转移发生率为43．0％（265／616），颈外侧区（Ⅱ＋Ⅲ＋Ⅳ区）淋巴结转移发生率为19．2％（118／616）。肿瘤突破包膜、直径〉1cm者同侧淋巴结转移发生率明显升高（P〈0．05）。滤泡状癌淋巴结转移发生率明显低于乳头状癌（P〈0.05）。结论分化型甲状腺癌颈部淋巴结转移最常见的部位是中央区，其次为颈外侧区。初次手术应常规清扫颈部中央区淋巴结。当肿块直径〉1cm、肿瘤突破甲状腺包膜时或B超、CT等影像学检查有颈部淋巴结转移时，应常规清扫颈外侧区淋巴结。乳头状癌淋巴结转移发生率更高．应区别对待。Objective To investigate the risk factors of cervical lymph node metastasis in patients with differentiated thyroid carcinoma. Methods The clinical data of 616 cases of differentiated thyroid carcinoma treated in this hospital last 8 years were reviewed retrospectively. The association of cervical lymph node metastasis with sex, age, multiple focus, tumor size, amic- ula invasion and pathological features was analyzed. Results Among 616 patients with thyroid carcinoma, 566 were papillary thyroid carcinoma and 50 were follicular thyroid carcinoma. The lymph node metastasis rate was 43.0%（265/616） in the VI region, and 19.02%（118/616） in II ＋ III ＋IV region. The rate of cervical lymph node metastasis significantly increased in patients with primary tumor〉 lcm or amicula invasion in the VI region and ipsilateral II ＋ Iit ＋ IV region（P〈O,05）. The rate of lymph node metasta- sis in patients with follicular carcinoma was lower than that in patients with papillary carcinoma（P〈0.05）. Conclusion The results indicate that lymph nodes in VI region should be dissected routinely and the nodes in Ⅱ＋Ⅲ＋Ⅳregion should be dissected when the tumor diameter 〉 1.0cm and with amicula invasion or demonstration of cervical lymph node metastasis by imaging examinations.

关 键 词：分化型甲状腺癌 颈淋巴结清扫术 颈部淋巴转移 乳头状癌 滤泡状癌 

分 类 号：R739.8[医药卫生—肿瘤]