桥本甲状腺炎合并甲状腺乳头状癌临床病理特征及中央区淋巴结转移的风险因素分析  

Clinicopathologic features of Hashimoto's thyroiditis complicated with papillary thyroid carcinoma and risk factors for central lymph node metastasis

作　　者：单立群 崔传友[1] 孙景福[1] SHAN Li-qun;CUI Chuan-you;SUN Jing-fu(Department of Thyroid Pancreatic Surgery,the Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]山东大学第二医院甲状腺胰腺外科,山东济南250033

出　　处：《中国现代普通外科进展》2021年第4期278-281,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨桥本甲状腺炎(HT)合并甲状腺乳头状癌(PTC)的临床病理特征及颈部中央区淋巴结转移的危险因素。方法:回顾性分析山东大学第二医院甲状腺胰腺外科2016年6月至2019年11月手术治疗的121例HT合并PTC患者临床病理资料,通过单因素和多因素分析中央区淋巴结转移的危险因素。结果:121例HT合并PTC患者中,男性7例(5.8%),女性114例(94.2%);年龄<55岁93例(76.9%),≥55岁28例(23.1%);肿瘤最大径≤5 mm者40例(33.1%),>5 mm者81例(66.9%);肿瘤位于单侧腺叶者90例(74.4%),双侧腺叶者31例(25.6%);多灶肿瘤45例(37.2%),单灶肿瘤76例(62.8%);有包膜侵犯56例(46.3%),无包膜侵犯65例(53.7%);合并结节性甲状腺肿13例(10.7%),未合并结节性甲状腺肿108例(89.3%);中央区淋巴结有转移52例(43%),中央区淋巴结无转移69例(57%)。单因素和多因素分析发现,肿瘤最大径>5 mm、包膜侵犯是淋巴结转移的危险因素(P<0.05),性别、年龄、肿瘤位于单侧或双侧、是否多灶性、是否合并结节性甲状腺肿与中央区淋巴结转移无关(P>0.05)。结论:HT合并PTC易出现中央区淋巴结转移,肿瘤最大径>5 mm、包膜侵犯是中央区淋巴结转移的危险因素,对合并高危因素的患者应行预防性中央区淋巴结清扫。Objective:To investigate the clinicopathological characteristics of Hashimoto's thyroiditis(HT)combined with papillary thyroid carcinoma(PTC)and the risk factors of central lymph node metastasis.Methods:We retrospectively reviewed the clinicopathological data of 121 HT complicated with PTC patients who underwent surgical treatment from June 2016 to November 2019 in the Department of Thyroid and Pancreatic Surgery of the Second Hospital of Shandong University.Univariate and multivariate logistic regression models were used to analyze related factors that may affect central lymph node metastasis in HT complicated with PTC patients.Results:Among 121 patients,7 cases were male(5.8%)and 114 cases were female(94.2%).93 patients were younger than 55 years old(76.9%)and 28 patients were older than 55 years old(23.1%).The cases of largest tumor size≤5mm were 40(33.1%)and 81 cases(66.9%)>5 mm.The cases of tumor which was located in unilateral glandular lobe were 90(74.4%)and 31 cases(25.6%)were located in bilateral glandular lobe.45 cases were multifocal tumor(37.2%)and 76 cases(62.8%)were single focus tumors.56 cases(46.3%)with capsular invasion and 65 cases(53.7%)without capsular invasion.13 cases(10.7%)with nodular goiter and 108 cases(89.3%)without nodular goiter.The cases of central lymph node metastasis were 52(43%)and 69 cases(57%)without central lymph node metastasis.Univariate and multivariate analysis found that largest tumor size>5 mm and capsular invasion were risk factors for central lymph node metastasis(P<0.05).Gender,age,tumor location,multifocal,and nodular goiter were not related to central lymph node metastasis(P>0.05).Conclusion:HT complicated with PTC patients often appeared central lymph node metastasis.The largest tumor size>5 mm and capsular invasion are risk factors for central lymph node metastasis.Patients with high-risk factors should undergo preventive central lymph node dissection.

关 键 词：甲状腺肿瘤 桥本甲状腺炎 中央区淋巴结 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]