甲状腺乳头状癌合并桥本氏甲状腺炎右侧喉返神经深层淋巴结转移情况分析  

Analysis of metastasis of lymph node posterior to right recurrent laryngeal nerve in patients with papillary thyroid carcinoma and Hashimoto’s thyroiditis

作　　者：李晨 田文 夏绍友 杨华夏 Li Chen;Tian Wen;Xia Shaoyou;Yang Huaxia(Department of General Surgery,First Medical Center,The General Hospital of Chinese People’s Liberation Army,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第一医学中心普通外科,北京100853

出　　处：《解剖学杂志》2021年第4期326-331,共6页Chinese Journal of Anatomy

基　　金：北京市科技计划课题“首都特色”专项(Z141107002514102)。

摘　　要：目的:探讨甲状腺乳头状癌(PTC)合并桥本氏甲状腺炎(HT)患者右侧喉返神经深层淋巴结(LN-prRLN)的转移情况。方法:选取本院2015年7月至2019年12月收治的123例PTC合并HT及150例单纯PTC病例为研究对象,分为观察组、对照组。所有患者均行中央区淋巴结完整清扫,比较2组颈部中央区淋巴结转移情况,分析观察组不同临床病理特征患者LN-prRLN转移率,采用多因素logistic回归分析探讨观察组发生LN-prRLN转移的独立影响因素。结果:术后病理结果提示观察组、对照组中央区淋巴结转移率、LN-prRLN转移总转移率、单纯转移率,分别为43.1%、48.0%,26.8%、30.0%,4.9%、9.3%,2组比较差异均无统计学意义。单因素分析表明观察组癌灶最大径>2.0 cm、癌灶数量≥2个、癌灶位于甲状腺下极、肿瘤侵犯包膜、甲状腺周围组织、中央区淋巴结清扫总数≥5枚、合并其他中央区淋巴结转移、颈侧区淋巴结转移患者LN-prRLN转移发生率显著升高,差异均有统计学意义。多因素logistic回归分析结果表明,癌灶数量≥2个与肿瘤侵犯包膜是观察组LN-prRLN转移发生的独立危险因素(OR=1.986、3.338)。结论:1/4的PTC合并HT患者会出现LN-prRLN转移,在清扫右侧中央区淋巴结时应常规探查LN-prRLN,当癌灶数量≥2个与肿瘤侵犯包膜时推荐尽量完整清扫LN-prRLN。Objective:To analyze the metastasis of lymph node posterior to right recurrent laryngeal nerve(LN-prRLN)in patients with papillary thyroid carcinoma(PTC)and Hashimoto's thyroiditis(HT).Methods:123 patients with PTC and HT and 150 patients with PTC from July 2015 to December 2019 were enrolled the in study as observation group and control group respectively.All cases underwent complete dissection of lymph node,and the metastasis of central compartment lymph node was compared between two groups.The incidence of LN-prRLN metastasis was compared among different patients with clinicopathological features,and multivariate logistic regression analysis was performed to explore the independent risk factors of LN-prRLN m etastasis in observation group.Results:Postoperative pathological results showed that the incidence of central compartment lymph node metastasis,total incidence of LN-prRLN metastasis,and incidence of alone metastasis of LN-prRLN in observation group and control group were 43.1%and 48.0%,26.8%and 30.0%,4.9%and 9.3%,respectively.And there were no statistically significant differences between two groups.Single factor analysis result showed that incidence of LN-prRLN metastasis in patients with tumor maximum diameter>2.0 cm,tumor number≥2,tumor located in the low part of parathyroid gland,thyroid capsule invasion,peripheral tissue invasion,the dissection number of central compartment lymph node≥5 pieces,combined with significantly increased central compartment lymph node metastasis and lateral lymph node metastases in observation group.Multivariate logistic regression analysis showed that tumor number≥2 and thyroid capsule invasion were the independent risk factors for patients with LN-prRLN metastases in observation group(OR=1.986,3.338).Conclusion:LN-prRLN metastases occur in a quarter of patients with PTC and HT,so LN-prRLN should be routinely explored during dissection of central compartment lymph node,and those patients with tumor number≥2 and thyroid capsule invasion are recommended to complete

关 键 词：甲状腺乳头状癌 桥本氏甲状腺炎 右侧喉返神经深层淋巴结 淋巴结转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤] R581.4[医药卫生—临床医学]