甲状腺癌改良根治术及颈廓清术后甲状腺癌伴淋巴结转移的超声诊断  

Ultrasound diagnosis of lymph node metastasis in thyroid cancer patients after modified radical operation and neck expurgation

作　　者：王朋会[1] 林纪光[1] 陈激[1] 

机构地区：[1]温州医科大学附属第三医院(瑞安市人民医院)超声科,浙江省瑞安市325200

出　　处：《中华全科医学》2015年第5期804-806,共3页Chinese Journal of General Practice

基　　金：浙江省温州市科技局科研基金(Y20130160)

摘　　要：目的观察甲状腺改良根治术及颈廓清术后甲状腺癌伴淋巴结转移的超声表现以及分布规律,探讨超声诊断甲状腺癌伴淋巴结转移的临床价值。方法选取瑞安市人民医院2012年1月—2013年12月收治的甲状腺癌且予以甲状腺改良根治术以及颈廓清术的128名患者,术后行超声检查,依照颈部分区对疑似转移淋巴结进行标记,观察转移性淋巴结的超声影像,同期将颈部分区的疑似淋巴结送病理检查,应用Logistic回归分析经病理证实的转移性淋巴结的超声表现与淋巴结转移的相关性。结果 128例患者经超声诊断后102例淋巴结有转移,病理证实95例,超声诊断淋巴结转移的准确率为93.14%（95/102）;廓清术标本中转移性淋巴结Ⅰ区、Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区、Ⅵ区的转移率分别为10.53%、33.78%、48.94%、55.17%、35.59%、67.39%,Ⅵ区淋巴结转移率（67.39%）最高;转移性淋巴结与非转移性淋巴结的超声表现差异具统计学意义（P〈0.05）;有无微钙化以及淋巴门与淋巴结转移相关（P〈0.05,95%置信区间：1.261～2.106,1.532～2.503）。结论甲状腺癌淋巴转移的关键位置为颈部Ⅵ区,应严格注意扫查颈部Ⅵ区;有无微钙化以及淋巴门在诊断甲状腺癌淋巴结转移中具有一定应用价值。Objective To observe the ultrasonic manifestation and the distribution of lymph node metastasis in patients with thyroid carcinoma after modified thyroid radical resection and radical neck dissection,and evaluate the clinical value of ultrasound in the diagnosis of thyroid carcinoma accompanying lymph node metastasis. Methods We selected 128 patients with thyroid carcinoma who had been treated with thyroid improved radical resection and radical neck dissection between January 2012 and December 2013 from our hospital. We applied ultrasonography after the operation,marked on the neck where Lymph node was metastatic and observed ultrasonic tomography of metastatic lymph node. Meanwhile,we had pathological examination of suspected lymph mode and applied Logistic to analyze the ultrasonic imaging of improved metastatic lymph node and influence of lymph mode metastasis. Results Among the 128 patients,102 were diagnosed with the lymph node metastasis,in which 95 cases wer certified by pathology in 93. 14%（ 95 /102）; Among specimens of neck dissection,metastatic rate of lymph node Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,and Ⅵ were 10. 53%,33. 78%,48. 94%,55. 17%,35. 59%and 67. 39%,respectively. Ⅵ was the highest with 67. 39% among all the areas. The difference in ultrasonography between metastatic lymph node and non-metastatic lymph node were statistical（ P〈0. 05）; the calcification and lymph node portal was correlated with the lymph node metastasis（ P〈0. 05,95% CI： 1. 261 to 2. 106,1. 532 to 2. 503）.Conclusion The main area of thyroid carcinoma lymph node metastasis is VI region. We should pay more attentions to VI area of neck. The calcification and lymph node portal are of some application value in thyroid carcinoma lymph node metastasis.

关 键 词：甲状腺癌 淋巴结转移 超声诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]