甲状腺乳头状癌颈Ⅳ区阳性(Ⅲ区Ⅴ区阴性)时Ⅱ区淋巴结转移的研究  

Study on lymph node metastasis in levelⅡof thyroid papil⁃lary carcinoma with positive lymph nodes in levelⅣ(nega⁃tive in levelⅢandⅤ)

作　　者：徐胜前[1] 朱国华[1] 程剑峰[1] 周琰[1] XU Sheng-qian;ZHU guo-hua;CHENG Jian-feng;ZHOU Yan(Department of General Surgery,Affiliated Jiangyuan Hospital,Jiangsu Institute of Nuclear Medicine,Wuxi 214063,China)

机构地区：[1]江苏省原子医学研究所附属江原医院普外科,江苏无锡214063

出　　处：《中国现代普通外科进展》2024年第12期943-947,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨甲状腺乳头状癌(PTC)颈Ⅳ区阳性(Ⅲ区Ⅴ区阴性)患者颈Ⅱ区淋巴结转移的影响因素,评估术中行超选择性颈部淋巴结清扫术的可行性。方法:回顾性分析我院173例PTC颈Ⅳ区阳性(Ⅲ区Ⅴ区阴性)行颈部淋巴结清扫术患者的临床资料,研究患者年龄、性别、肿瘤大小、肿瘤部位、颈Ⅵ区及Ⅳ区淋巴结转移数等相关因素对颈Ⅱ区淋巴结转移的影响。结果:颈Ⅱ区淋巴结总体转移率为19.6%。单因素分析结果显示,肿瘤单发灶、下极部位肿瘤、下极肿瘤且肿瘤长径<1.0 cm、Ⅵ区+Ⅳ区淋巴结转移数<2个与颈Ⅱ区淋巴结转移均呈负相关(P<0.05);中央区淋巴结跳跃性转移、肿瘤大小+Ⅵ区淋巴结转移数、性别、年龄、肿瘤大小以及Ⅳ、Ⅵ区淋巴结转移数与颈Ⅱ区淋巴结转移无关(P>0.05);进一步分析发现肿瘤长径<1.0 cm且中央区淋巴结无转移时,Ⅱ区淋巴结未发现转移。Logistic回归分析结果显示,上极部位肿瘤是颈Ⅱ区淋巴结转移的独立危险因素(OR=8.023,P<0.001);当肿瘤位于中极(OR=2.014,P=0.207)、多发灶(OR=2.163,P=0.083)时,颈Ⅱ区淋巴结转移风险更高;存在中央区淋巴结跳跃性转移时,颈Ⅱ区淋巴结转移风险较低(OR=0.316,P=0.100)。结论:下极部位肿瘤且肿瘤长径<1.0 cm、甲状腺乳头状微小癌(PTMC)不伴中央区淋巴结转移(CLNM)、颈Ⅳ区淋巴结单个转移不伴CLNM的PTC颈Ⅳ区阳性(Ⅲ区Ⅴ区阴性)患者,颈Ⅱ区淋巴结转移率相对更低,可以考虑行超选择性颈淋巴结清扫术。Objective:To investigate the influencing factors of level Ⅱ lymph node metastasis in patients with thyroid papillary carcinoma(PTC)with positive level Ⅳ(level Ⅲ and Ⅴ negative),and to evaluate the feasibility of superselective cervical lymph node dissection.Methods:This study was retrospectively analyzed the clinicopathological data of 173PTC patients with level Ⅳ positive(level Ⅲ and Ⅴ negative)who underwent cervical lymph node dissection in our hospital.We also studied the effects of related factors such as age,sex,tumor size,tumor location,number of lymph node metastasis in level Ⅵ and Ⅳ on lymph node metastasis in levelⅡ.Results:The overall metastatic rate of level Ⅱ lymph nodes was 19.6%.Univariate analysis showed that single tumor,lower pole tumor,lower pole tumor with a maximum diameter less than 1.0cm,less than 2 lymph node metastases in level Ⅵ+Ⅳ were significantly negatively correlated with lymph node metasta-sis in level Ⅱ(P<0.05);There was no significant correlation between skip lymph node metastasis in central region,tumor size+number of lymph node metastasis in level Ⅵ,sex,age,tumor size,and number of lymph node metastasis in level Ⅳ and Ⅵ,and lymph node metastasis in level Ⅱ(P>0.05).Further analysis showed that when the tumor was<1.0cm and there was no lymph node metastasis in central region,no metastasis was found in level Ⅱ lymph nodes.Multivariate analysis:Upper pole tumor was an independent risk factor for level Ⅱ lymph node metastasis(OR=8.023,P<0.001).The risk of level Ⅱ lymph node metastasis was higher in patients with middle pole tumor(OR=2.014,P=0.207)or multiple tumors(OR=2.163,P=0.083).And the risk of level Ⅱ lymph node metastasis was lower in patients with skip metastasis in central region(OR=0.316,P=0.100).Conclusion:For patients with positive cervical levelⅣof PTC(negative for level Ⅲ and Ⅴ),lower ex-tremal tumor,especially<1.0 cm,or papillary thyroid microcarcinoma(PTMC)without central lymph node metastasis(CLNM),or single lymph node

关 键 词：甲状腺乳头状癌 淋巴结转移 颈Ⅳ区 颈Ⅱ区 

分 类 号：R736.1[医药卫生—肿瘤]