甲状腺乳头状癌合并桥本甲状腺炎中央区阴性淋巴结清扫的临床分析  

Dissection of Negative Lymph Nodes in Central Cervical Zone for Papillary Thyroid Carcinoma Complicated with Hashimoto's Thyroiditis

作　　者：李晨[1] 田文[1] 夏绍友[1] 杜晓辉[1] 陈凛[1] LI Chen TIAN Wen XIA Shao-you et al(General Hospital of Chinese People＇s Liberation Army ,Beijing 100853, China)

机构地区：[1]解放军总医院,北京100853

出　　处：《肿瘤学杂志》2017年第4期282-285,共4页Journal of Chinese Oncology

基　　金：科技创新苗圃基金(301医院);NLR与miRNA基因检测在甲状腺乳头状癌诊治中的临床研究(15KMM37)

摘　　要：[目的]探讨甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)患者中央区阴性淋巴结清扫的理论依据及应用策略。[方法]回顾性分析294例PTC初治患者术中阴性淋巴结清扫情况,按照有无合并HT分为合并组(A组)和单纯组(B组)。比较两组病理特征对术中阴性淋巴结清扫的影响。[结果]中央区淋巴结转移发生率A组低于B组(43.8%vs 62.4%,P=0.040),淋巴结清扫总数A组多于B组(9.14±2.37 vs 6.75±0.97,P<0.001),阴性淋巴结清扫数A组多于B组(6.56±0.41 vs 2.83±0.47,P=0.002)。颈淋巴结术后病理阳性率A组低于B组(53.39%vs 63.11%,P=0.012)。手术时间A组高于B组(82.22 min vs 70.32 min),手术出血量A组多于B组(37.53±2.47ml vs 22.46±1.31ml,P=0.040)。[结论 ]认识PTC合并HT患者中央区淋巴结转移特点,合理控制中央区阴性淋巴结清扫数目及范围,可有效降低术后并发症。[Objective] To analyze the features of dissected central cervical zone negative lymph nodes in patients of papillary thyroid carcinoma （PTC） complicated with Hashimoto＇s thyroiditis （HT）. [Method] Two hundred and ninety four PTC patients,including 57 cases（group A） complicated with HT.and 237 cases（group B） without HT were analyzed retrospectively. The pathological features of intraoperatively dissected negative lymph nodes were compared between two groups. [Results] In group A,the metastasis rate of central lymph nodes was lower than that in group B （43.8% vs 62.4%, P=0.040）, the average number of lymph nodes dissected was higher than that in group B （9.14±2.37 vs 6.75±0.97,P〈0.001 ）,and the average number of negative lymph nodes dissected was higher than that in group B （6.56±0.41 vs 2.83±0.47,P=0.002）. The pathological positive rate in group A（53.39%） was lower than that in group B（63.11%）（P=0.012）. Group A had longer operation time（82.22min vs 70.32min） and more intraoperative blood loss（37.53±2.47ml vs 22.46±1.31ml,P=0.040）. [Conclusion] Based on characteristics of central cervical lymph node metastasis,the restriction of dissection number and range can effectively reduce postoperative complications in PTC with HT patients.

关 键 词：甲状腺乳头状癌 桥本甲状腺炎 阴性淋巴结清扫数目 

分 类 号：R736.1[医药卫生—肿瘤]