| 杨一飞,庞天舒.甲状腺微小乳头状癌颈部淋巴结转移影响因素的研究（附798例报道）[J].浙江中西医结合杂志,2015,25(12): |
| 甲状腺微小乳头状癌颈部淋巴结转移影响因素的研究（附798例报道） |
| Effective factors of cervical lymph node metastasis of papillary thyroid microcarcinoma ( 798 cases) |
| 投稿时间：2015-04-05 修订日期：2015-04-05 |
| DOI： |
| 中文关键词: 甲状腺微小乳头状癌 淋巴结 转移 影响因素 |
| 英文关键词:Papillary thyroid microcarcinoma Lymph nodes Metastasis Risk factors |
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| 中文摘要: |
| 目的 探讨甲状腺微小乳头状癌颈淋巴结转移规律及影响因素，为淋巴结清扫指征及范围的选择提供理论依据。 方法 回顾分析杭州余杭区第一人民医院2005年6月-2013年12月初次治疗的798例甲状腺微小乳头状癌患者的临床信息及病理资料，总结颈淋巴结转移规律及影响因素。 结果 798 例甲状腺微小乳头状癌颈淋巴结转移率为26.2% (209/798)，中央区及侧颈转移率为25.1% (200/798)、4.6%(37/798)。男性与女性中央区转移率分别为38.7% (82/212)、20.1%(118/586)（P﹤0.001；侧颈转移率7.1%(15/212)、3.8%(22/586），差异无统计学意义。≤45岁与﹥45岁患者中央区转移率为30.9% (150/485)、16% (50/313)，（P﹤0.001）。肿瘤D≤0.5CM与0.5CM﹤D≤1CM中央区转移率为17.8% (67/376)、31.5% (133/422)，侧颈淋巴结转移率为2.4% （9/376）、6.6%（28/422），（P﹤0.01）。单灶与多灶中央区转移率为22.4% (134/599)、33.2% (66/199),（P﹤0.01）。肿瘤未侵犯包膜和侵犯包膜侧中央区颈淋巴结转移率为22.1%（142/642）、37.2% (58/156)，侧颈淋巴结转移率为3.6% (23/642)、9%(14/156)，（P﹤0.01）。中央区淋巴结未转移而发生侧颈转移率的1.5%（9/598），中央区发生转移伴侧颈转移率为14%（28/200）（P﹤0.01）。 结论 甲状腺乳头状癌颈淋巴结转移在男性、低龄、多灶、肿瘤长径较大及肿瘤外侵的患者中更多见。在制定淋巴结清扫指征及范围时，应充分评估影响淋巴结转移的高危因素，实施个体化的清扫策略。 |
| 英文摘要: |
| Objective To discuss the effective factors and metastasis rules of cervical lymph node of papillary thyroid microcarcinoma, aimed to provide references for indications and range of lymph node dissection. Methods Reviewed the clinical information and pathological material of primary treatment of 798 cases of papillary thyroid microcarcinoma patients in The first people's Hospital of Hangzhou Yuhang from June 2005 to December 2013 by retrospective analysis, summarize cervical lymph node metastasis rules and effective factors. Results The lymph node metastasis rate of patients with papillary thyroid microcarcinoma was 26.2% (209/798), which of these of the central and lateral region were 25.1% (200/798) and 4.6%(37/798). Central region lymph nodes metastasis rates in male and female were respectively 38.7% (82/212), 20.1%(118/586), (P﹤0.001), and were 7.1%(15/212)、3.8%(22/586, in lateral region (P﹥0.05). Central region Lymph node metastasis rates of patients whose age≤45years old and ﹥45years old were30.9% (150/485)、16% (50/313)，（P﹤0.001）. The lymph node metastasis rate which diameter of tumour (D)≤0.5CM or 0.5CM﹤D≤1CM in central region were17.8% (67/376)、31.5% (133/422), and were 2.4%(9/376)、6.6%(28/422) in lateral region , (P﹤0.01). The lymph node metastasis rate of single and more nidi respectively were 22.4% (134/599), 33.2% (66/199), (P﹤0.01), in central region. The lymph node metastasis rate of tumors invasion or not were 3.6% (23/642) and 9%(14/156), in central region (P﹤0.01). The metastasis rates were 1.5%(9/598) and14%(28/200) in the lateral region when the lymph node infringe or not in central region. Conclusions Lymph node metastasis happens relatively more common in papillary thyroid microcarcinoma patients with the factors such as male, young age, multiple nidi, long diameter of tumor and invasion of tumor envelope. So when doctors establish the indications and range of lymph node dissection, it is need to pay attention to the high risk factors seriously which effect lymph node metastasis of papillary thyroid carcinoma, and establish the lymph node dissection strategy individually. |
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