甲状腺乳头状癌侧颈淋巴结转移的情况及影响因素研究  

Lateral cervical lymph node metastasis in papillary thyroid carcinoma and its risk factors

作　　者：张国梁[1] 瞿彩兴[1] 蒋鹏程[1] 左君波[1] 王晨 ZHANG Guoliang;QU Caixing;JIANG Pengcheng;ZUO Junbo;WANG Chen(Department of General Surgery,the Affiliated People’s Hospital of Jiangsu University,Zhenjiang 212002,Jiangsu Province,China)

机构地区：[1]江苏大学附属人民医院普外科,江苏镇江212002

出　　处：《西南医科大学学报》2020年第2期184-187,共4页Journal of Southwest Medical University

摘　　要：目的:探讨甲状腺乳头状癌颈侧区淋巴结转移的危险因素;并探讨颈侧区淋巴结术中活检的临床意义。方法:对135例甲状腺乳头状癌患者进行手术治疗,切除的甲状腺及淋巴结标本经术中快速冰冻切片,样本由两名病理学专家检查确诊。术中活检可疑的颈侧区淋巴结以确定是否行标准的改良颈侧区淋巴清扫术,活检的淋巴结分为两区:Ⅲ和/或Ⅳ区。记录患者的临床特征,原发肿瘤的组织病理学特征和淋巴结转移情况,并对结果进行统计分析。结果:37例(27.41%)活检颈侧区淋巴结有转移,其中23例(62.16%)在Ⅲ区,8例(21.62%)Ⅳ区,6例(16.22%)Ⅲ区Ⅳ区皆有转移;98例(72.59%)活检呈阴性,较大肿瘤(>10 mm)。患者年龄,累及被膜,多枚中央区淋巴结转移个数和颈外侧淋巴结转移有关(P<0.05)。结论:对于肿瘤较大,累及被膜,腺外侵犯,多枚中央区淋巴结转移(>3枚)的患者,术中行颈侧Ⅲ、IV区淋巴结术中活检有一定的临床意义。Objective:To investigate the risk factors for lateral cervical lymph node metastasis in papillary thy-roid carcinoma,and to explore the clinical significance of intraoperative biopsy of lateral cervical lymph nodes.Methods:A total of 135 patients with papillary thyroid carcinoma underwent surgical treatment.The excised thyroidgland and lymph node specimens underwent intraoperative rapid frozen sectioning and were examined and diagnosedby two pathologists.Intraoperative biopsy of the suspicious lateral cervical lymph nodes was performed to determinewhether a standard modified lateral cervical lymph node dissection should be performed.The biopsied lymph nodeswere divided into two regions:region III and/or region IV.The clinical features of patients,the histopathological fea-tures of the primary tumor,and the status of lymph node metastasis were recorded,and the results were statisticallyanalyzed.Results:Thirty-seven(27.41%)of the patients had lateral cervical lymph node metastases according tothe biopsy results,of whom 23 patients(62.16%)had metastases in region III,8 patients(21.62%)in region IV,and 6 patients(16.22%)in both regions III and IV.Ninety-eight patients(72.59%)had negative biopsy results andrelatively large tumor sizes(>10 mm).Patient age,involvement of the capsule,and the number of multiple lymphnode metastases in the central region(>3)were significantly associated with lateral cervical lymph node metastasis(P<0.05).Conclusion:For patients with relatively large tumors,involvement of the capsule,extraglandular inva-sion,and multiple lymph node metastases in the central region(>3),intraoperative biopsy of cervical lymph nodesin regions III and IV has certain clinical significance.

关 键 词：甲状腺乳头状癌 颈侧区淋巴结 术中活检 快速冰冻切片病理检查 

分 类 号：R736.1[医药卫生—肿瘤]