甲状腺癌颈部淋巴结转移的超声诊断及分布研究  

Ultrasound Diagnosis and Distribution Study on Thyroid Carcinoma's Lymph Nodes Metastases

作　　者：黄崑[1] 赵一[2] 刘艳君[1] 翟齐西[1] 欧国成[1] 王学梅[1] 

机构地区：[1]中国医科大学附属第一医院超声科,辽宁省沈阳市110001 [2]中国医科大学附属第一医院放射科,辽宁省沈阳市110001

出　　处：《中国全科医学》2013年第33期3995-3997,共3页Chinese General Practice

摘　　要：目的探讨甲状腺癌颈部淋巴结转移的超声表现及分布规律。方法 2011年1—12月中国医科大学附属第一医院外科诊断甲状腺癌伴淋巴结转移并行甲状腺癌改良根治术及颈廓清术的患者136例,术前行超声检查,按颈部分区标记可疑转移淋巴结及观察淋巴结超声表现。同期行颈廓清术并将淋巴结按标记分区送病理检查,超声标记的可疑淋巴结做病理对照,记录术后颈廓清术标本中转移淋巴结的数量及其分布,进行统计学分析。采用Logistic回归分析病理诊断阳性淋巴结的超声表现与淋巴结转移的相关性。结果超声诊断转移淋巴结268枚,病理证实转移淋巴结221枚,超声诊断准确率为82.46%。颈廓清术标本中转移淋巴结在颈部Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅵ区的阳性率分别为53.85%(21/39)、70.83%(34/48)、70.00%(35/50)、30.58%(37/121)和87.85%(94/107),差异有统计学意义(χ2=83.70,P<0.05);其中颈部Ⅱ、Ⅲ、Ⅳ区阳性率比较,差异无统计学意义(P>0.05);转移淋巴结在Ⅵ区的阳性率高于Ⅱ、Ⅲ、Ⅳ区,差异有统计学意义(χ2值分别为19.76、6.67和7.41,P<0.01)。Logistic回归分析,结果显示,淋巴结大小、形态、回声与淋巴结转移无相关性,有无淋巴门、微钙化与淋巴结转移有相关性。结论颈Ⅵ区是甲状腺癌的颈部淋巴转移的重要部位,对颈Ⅵ区进行清扫十分必要;无淋巴门和淋巴结微钙化对甲状腺癌的诊断有一定的临床意义。Objective To analyze the ultrasound manifestations and the distribution of lymph nodes metastases in pa- tients with thyroid carcinoma. Methods 136 patients with thyroid carcinoma admitted to the First Affiliated Hospital of China Medical University were given preoperative ultrasound examination of cervical parts to mark and localize the suspicious metastatic lymph nodes based on neck zonation and the ultrasound manifestations of lymph nodes were also observed. The radical neck dissec- tion was performed, and pathological examinations were performed on the dissected lymph nodes. The marked suspicious lymph nodes were compared pathologically. The number of metastatic lymph nodes of the samples and their distributions in areas I1 , II1, IV, V, VI were recorded and the obtained data were analyzed statistically. Association of ultrasound manifestations of metastatic lymph nodes and lymph nodes metastasis were performed by logistic regression analysis. Results Ultrasound detected 268 meta- static lymph nodes, while 221 of them were confirmed by pathology. The accuracy of ultrasound detection was 82. 46%. The posi- tive rate of metastatic lymph nodes from the neck dissection was 53.85 % （21/39）, 70. 83 % （34/48）, 70. 00% （35/50）, 30. 58% （37/121） and 87. 85% （94/107） respectively in areas of II , III, IV, V and VI, showing statistically significant differences （ x2 = 83.70, P 〈 0.05 ） . The positive rate between areas of II, m and IV showed no statistically significant differ- ence （ P 〉 0. 05 ） . The positive rate of metastatic lymph nodes in VI area was significantly higher than in areas of II , III and IV （X2 =19. 76, 6. 57 and 7.41, P 〈0. O1 ） . Logistic regression analysis showed that the size, shape and echo of lymph nodes were not related to their metastases, but were related to lymph hilus and microcalcification. Conclusion VI area is an important part of neck lymph nodes metastasis of well - differentiated thyroid carcinoma, and it is necessary for thyroid carcinoma patien

关 键 词：超声检查 多普勒 彩色 淋巴结 甲状腺肿瘤 

分 类 号：R736.1[医药卫生—肿瘤]