甲状腺乳头状癌右侧喉返神经深面淋巴结转移的临床病理因素分析  

Clinicopathological Factors Related to Right Paraesophageal Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

作　　者：姜琳[1] 张艳[1] 郑伟慧 王可敬 韩春 JIANG Lin;ZHANG Yan;ZHENG Wei-hui;WANG Ke-jing;HAN Chun(Institute of Cancer and Basic Medicine(ICBM)of Chinese Academy of Sciences,Cancer Hospital of the University of Chinese Academy of Sciences,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]中国科学院肿瘤与基础医学研究所,中国科学院大学附属肿瘤医院,浙江省肿瘤医院,浙江杭州310022

出　　处：《肿瘤学杂志》2020年第5期428-432,共5页Journal of Chinese Oncology

基　　金：浙江省医药卫生科技计划(2015KYB065,2020KY464)。

摘　　要：[目的]探讨甲状腺乳头状癌患者右侧喉返神经深面淋巴结转移的临床病理因素及其对预后的影响。[方法]回顾性分析191例甲状腺乳头状癌患者资料,对所有患者的手术情况、临床病理参数、随访情况进行统计分析。[结果]接受手术治疗患者191例,其中病理学诊断确诊右侧中央区淋巴结转移率54.9%,右侧喉返神经深面淋巴结转移率23.6%,右侧侧颈部淋巴结转移率19.9%。单因素分析显示,右侧喉返神经深面淋巴结转移与性别(P=0.001)、肿瘤直径(1.0cm为界)(P<0.001)、是否包膜外侵犯(P<0.001)、是否喉返神经浅面淋巴结转移(P<0.001)、是否侧颈部淋巴结转移(P<0.001)相关。多因素分析显示,男性(P=0.005)、肿瘤包膜外侵犯(P=0.020)、喉返神经浅面淋巴结转移(P=0.007)、侧颈部淋巴结转移(P=0.047)是喉返神经深面淋巴结转移的独立危险因素。[结论]对于男性、肿瘤有包膜外侵犯、喉返神经浅面淋巴结有转移、侧颈部淋巴结有转移的患者,在有效保护喉返神经及下极甲状旁腺的同时,建议清扫右侧喉返神经深面淋巴结。[Objective] To explore the clinicopathological factors related to the metastasis of right paraesophageal lymph nodes in patients with papillary thyroid carcinoma. [Methods] One hundred and ninety-one patients with papillary thyroid carcinoma were enrolled. The operation,clinicopathological parameters and follow-up data of all patients were analyzed. [Results] In this series of patients the metastasis rate of the right central lymph nodes was 54.9%(105/191),the metastasis rate of the right paraesophageal lymph nodes was 23.6%(45/191),and the metastasis rate of the right lateral lymph nodes was19.9%(38/191),respectively. Univariate analysis showed that there was a significant correlation between the right paraesophageal lymph node metastasis with the gender(P=0.001),the tumor diameter(P<0.001),extrathyroid invasion(P<0.001),superficial lymph node metastasis of RLN(P<0.001),and right lateral lymph node metastasis(P<0.001). Multivariate analysis showed that male gender(P=0.005),extrathyroid invasion(P=0.020),superficial lymph node metastasis of RLN(P=0.007),right lateral lymph node metastasis(P=0.047) were independent risk factors of right paraesophageal lymph node metastasis. [Conclusion]Male patients with extrathyroid invasion,superficial lymph node metastasis of the recurrent laryngeal nerve,or right lateral lymph node metastasis are suggested to dissect the right paraesophageal lymph nodes on the basis of effective protection of recurrent laryngeal nerve and lower parathyroid gland.

关 键 词：甲状腺乳头状癌 中央区淋巴结清扫 喉返神经深面淋巴结 

分 类 号：R736.1[医药卫生—肿瘤]