甲状腺癌的超声诊断和淋巴结转移1023例分析  

Ultrasonic diagnosis and lymph node metastasis of thyroid carcinoma:clinical study on 1023 cases

作　　者：贝一冰 俞甲子[1] 王雅平[1] 陈伯赞[1] 华鲁纯[1] 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《复旦学报（医学版）》2014年第5期658-661,共4页Fudan University Journal of Medical Sciences

摘　　要：目的分析近年来甲状腺癌分类构成比的改变,探讨超声检查在术前鉴别甲状腺良、恶性结节的价值以及甲状腺乳头状微灶癌手术常规一期行同侧Ⅵ区淋巴结清扫术的意义。方法回顾性分析2008年1月至2012年12月经复旦大学附属华山医院外科手术的1 023例甲状腺癌超声诊断及病理结果等临床资料。结果 1 023例甲状腺癌中,乳头状癌约占97.0%,其中乳头状微灶癌约占44.7%。5项B超影像指标用于提示甲状腺结节性质为癌,其约登指数分别为:细钙化61.1%,边界模糊65.0%,细钙化与边界模糊并存54.4%,血供增加33.0%,低回声6.7%。B超用于鉴别颈淋巴结转移的约登指数为39.9%。137例甲状腺乳头状微灶癌术中一期行同侧Ⅵ区淋巴结清扫术,淋巴结转移阳性率为43.8%。结论近年来乳头状癌在甲状腺癌分类构成比中所占比例很大。术前超声检查对鉴别甲状腺结节性质具有较高的诊断价值。甲状腺乳头状微灶癌Ⅵ区淋巴结转移阳性率高,必须常规一期行同侧Ⅵ区淋巴结清扫术。Objective To explore the change of constituent ratio of thyroid carcinoma in recent years, study the value of ultrasound in the diagnosis of benign or malignant thyroid nodules before operation, and to discuss the significance of thyroidectomy with routine level VI lymph nodes dissection simutaneously for thyroid papillary microcarcinoma. Methods A retrospective study was carried out to review the clinical data of 1 023 patients who received thyroidectomy due to thyroid carcinoma in Huashan hospital, Shanghai, China, from Jan. , 2008 to Dec. , 2012. Results In the 1 023 cases, papillary thyroid carcinoma accounted for 97. 0%, 44. 7% of which were papillary microcarcinoma. Youden indexes of 5 ultrasound characters for differentiating the nature of thyroid nodules were as follows., microealcifieation 61. 1%, infiltrative margin 65. 0%, concurrent of microcalcification and infilrative margin 54. 4%, increased vascularity 33. 0%, and hypoechoic 6. 7%. Youden index for differentiation of lateral lymph node metastasis by ultrasonography was 39. 9%. One hundred and thirty-seven patients suffering from thyroid papillary microcarcinoma underwent thyroidectomy with level VI lymph nodes dissection at the same time, and 43. 8% of them had lymph node metastasis. Conclusions Papillary thyroid carcinoma accounts for a large proportion of thyroid carcinoma in recent years. Preoperative ultrasonography has a high accuracy in differentiating the nature of thyroid nodules. Since level ＂VI lymph nodes metastasis is common in patients suffering from thyroid papillary microcarcinoma,it is essential to perform the thyroidectomy with level VI lymph nodes dissection at the same time.

关 键 词：甲状腺癌 超声诊断 淋巴结清扫 

分 类 号：R736.1[医药卫生—肿瘤]