甲状腺乳头状癌临床及中央区淋巴结转移影响因素分析  

Clinical effect of papillary thyroid carcinoma and the influencing factors of lymph node metastasis to the central region

作　　者：庞飞雄[1] 张嘉越[1] 冷津立[1] 李松明[1] 

机构地区：[1]中国人民解放军第三〇三医院普通外科,南宁530021

出　　处：《中国临床新医学》2017年第12期1165-1168,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)临床疗效及中央区淋巴结转移的影响因素,为个体化手术治疗提供临床依据。方法回顾性分析201例PTC的临床资料,将患者的年龄、性别、肿瘤大小、包膜情况、肿瘤分期等影响因素,进行统计分析,探讨中央区淋巴结转移的影响因素。结果该组201例PCT均行个体化手术治疗,TNM分期Ⅰ期108例,Ⅱ期43例,Ⅲ期42例,Ⅳ期8例。该组无围手术期死亡病例,术后并发症少,术后未出现气胸、乳糜瘘、气管食管瘘、永久性甲状旁腺功能低下、喉返神经损伤,住院期间出现一过性低钙血症2例(1.0%)。术后随访半年至5年,发现局部复发2例(1.0%),淋巴结转移2例(1.0%),远处转移1例(0.5%)。中央区淋巴结转移率为53.7%(108/201),侧颈区淋巴结转移率为64.8%(70/108)。影响中央区淋巴结转移的影响因素为TNM分期和肿瘤穿透被膜。结论 PTC需根据不同临床特点给予个体化手术治疗;中央区淋巴结转移率高,建议所有患者均常规清扫中央区淋巴结。对于中央区淋巴结转移的患者,建议行侧颈区淋巴结清扫术。Objective To analyze the therapeutic effect of papillary thyroid carcinoma（PTC） and the characteristics of lymph node metastasis to the central area.Methods The clinical data of 201 patients with PTC in our hospital were retrospectively analyzed. The factors including age, sex, tumor size, capsule status and tumor staging were analyzed statistically, and the influencing factors of lymph node metastasis to the central area were analyzed.Results The 201 patients underwent individualized surgical treatment among whom the TNM stage Ⅰ was found in 108 cases, stage Ⅱ in 43 cases, stage Ⅲ in 42 cases and stage Ⅳ in 8 cases. There was no death during the perioperative period. Rare complications occurred postoperatively. There were no pneumothorax, chylous fistula, tracheo-esophageal fistula, perpetual hypoparathyroidism and injury of recurrent laryngeal nerve. Transient hypocalcemia occurred in 2 cases during hospitalization. All the patients were followed up for 6 months to 5 years and local recurrence occurred in 2 cases, lymph node metastasis in 2 cases, and distant metastasis in 1 case, with 53.7% of （108/201） lymph node metastasis to the central area and 64.8% of （70/108） lymph node metastasis to the lateral cervical region. Logistic regression analysis showed that TNM stages and tumor penetrating membrane were the risk factors of lymph node metastasis to the central area.Conclusion Individualized treatment should be performed on the patients with PTC according to their different clinical features. Lymph node dissection is necessary for the patients whose incidence of lymph node metastasis to the central area is high. In the patients with lymph node metastases to the central region, lateral cervical lymph node dissection is recommended.

关 键 词：甲状腺乳头状癌 淋巴结转移 手术治疗 

分 类 号：R736.1[医药卫生—肿瘤]