甲状腺乳头状癌右侧喉返神经后方淋巴结转移的相关因素及术前评估  

Risk factors and preoperative evaluation of lymph nodes posterior to right recurrent laryngeal nerve metastasis in thyroid papillary carcinoma

作　　者：张挺[1] 曲幽 贺亮[1] 邵亮[1] 张大林[1] 吕承州 张平[1] 张浩[1] Zhang Ting;Qu You;He Liang;Shao Liang;Zhang Dalin;La Chengzhou;Zhang Ping;Zhang Hao(Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院甲状腺外科,沈阳110001 [2]天津医科大学总医院甲状腺外科

出　　处：《中华医学杂志》2018年第22期1775-1779,共5页National Medical Journal of China

摘　　要：目的对甲状腺乳头状癌（PTC）右侧喉返神经后方淋巴结（LN-prRLN）转移的相关因素及术前评估进行探究。方法回顾性分析中国医科大学附属第一医院甲状腺外科2015年8月至2016年10月收治的301例行手术治疗的右叶或双叶PTC患者的临床资料，分析LN-prRLN转移与患者临床病理资料等因素的相关性，通过受试者工作特征（ROC）曲线对LN-prRLN的强化CT差值进行分析。结果46例患者存在LN-prRLN转移。单因素分析结果显示年龄、肿瘤直径、喉前淋巴结转移、右侧喉返神经前方淋巴结（LN-arRLN）转移数量、右侧侧颈淋巴结转移数量与LN-prRLN转移相关（均P〈0．05）。多因素logistic回归分析结果显示LN-arRLN转移及右侧侧颈淋巴结转移是LN-prRLN转移的独立相关因素（均P〈0．05）。甲状腺CT强化CT差值的ROC曲线下面积为0．948（P〈0．001），切点值为72Hu，最佳灵敏度及特异度分别为90．5％及94．1％，此时约登指数为0．846。结论当PTC患者存在LN-arRLN转移或右侧侧颈淋巴结转移，尤其当术前增强CT显示LN-prRLN且强化cT差值较大（〉172Hu）时，建议行LN-prRLN清扫术。Objective To investigate the risk factors and preoperative evaluation of lymph nodes posterior to right recurrent laryngeal nerve （LN-prRLN） metastasis in papillary thyroid carcinoma （ PTC ）. Methods Clinical data of 301 patients with right or double lobes who underwent surgery between August 2015 and October 2016 in the Department of Thyroid Surgery, the First Hospital of China Medical University, were retrospectively analyzed. The relationships between LN-prRLN metastasis and clinical pathology data and other factors were analyzed. The enhanced CT difference of LN-prRLN was analyzed by receiver operating characteristic （ROC） curves. Results LN-prRLN metastasis was detected in 46 patients. Univariate analysis showed that age, tumor diameter, Delphian lymph node metastasis, lymph nodes anterior to right recurrent laryngeal nerve （LN-arRLN） metastasis number, and the number of lateral compartment lymph node metastases were significantly associated with LN-prRLN metastasis （ all P 〈 0.05 ）. Multivariate logistic regression analysis showed that LN-arRLN metastasis and fight lateral compartment lymph node metastasis were independent risk factors for LN-prRLN metastasis （ both P 〈 0.05 ）. The area under the ROC curve for contrast-enhanced thyroid CT was O. 948 （ P 〈 O. 001 ） , the cut-off value was 72 Hu, and the best sensitivity and specificity were 90. 5% and 94. 1%, respectively, with a Youden index of 0. 846. Conclusion LN-prRLN dissection is recommended when there exists LN-arRLN metastasis or fight lateral compartment lymph node metastasis in patients with PTC, especially when preoperative contrastenhanced CT shows LN-orRLN and contrast-enhanced CT is ≥72 Hu.

关 键 词：甲状腺肿瘤 外科手术 颈淋巴结清扫术 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]