【摘要】 目的探讨甲状腺微小乳头状癌颈淋巴结转移的危险因素,分析高分辨率B超对颈侧区淋巴结转移的诊断价值和淋巴结清扫的安全性。方法回顾性分析2004年1月至2010年6月期间我院连续收治的284例甲状腺微小乳头状癌患者的临床资料。结果颈淋巴结转移率为29.2%(83/284),中央组淋巴结转移率为22.2%(63/284),同时发生中央组和颈侧区淋巴结转移率为4.9%(14/284),跳跃式(仅颈侧区)淋巴结转移率为2.1%(6/284)。年龄<45岁、肿瘤直径≥5 mm、多灶性和甲状腺外浸润者颈淋巴结转移率明显升高(P<0.05)。未发现跳跃式淋巴结转移的危险因素。行中央组+颈侧区淋巴结清扫患者的术后住院时间长于未行淋巴结清扫患者和行中央组淋巴结清扫者(P<0.05),3种手术后甲状旁腺和喉返神经损伤均为暂时性,损伤率差异均无统计学意义(P>0.05)。高分辨率B超对跳跃式淋巴结转移诊断的灵敏度、特异度、假阴性率和假阳性率分别为95.0%、75.0%、5.0%和25.0%,阳性和阴性预测值分别为90.5%和85.7%。结论对有颈淋巴结转移危险因素(年龄<45岁、肿瘤直径≥5 mm、多灶性、甲状腺外浸润)的患者建议行甲状腺全切除,同时行中央组淋巴结清扫,是安全的;高分辨率B超可作为颈侧区淋巴结转移的重要评估手段;对高度怀疑跳跃式淋巴结转移者应行功能性颈淋巴结清扫。更多还原

【Abstract】 Objective To investigate the risk factors for neck lymph node metastasis(LNM) in papillary thyroid microcarcinoma,analyze the diagnostic value of high resolution ultrasonography in lateral neck LNM,and evaluate the safety of lymph node dissection.Methods The clinical data of 284 patients with papillary thyroid microcarcinoma from Janaury 2004 to June 2010 in this hospital were analyzed retrospectively.Results Neck LNMs were found in 83 of 284 patients(29.2%),only central LNMs in 63 of 284 patients(22.2%),skip LNMs(only lateral LNMs) in 6 of 284 patients(2.1%),and both central and lateral LNMs in 14 of 284 patients(4.9%).Age <45 years,multifocality,tumor diameter ≥5 mm,and extra-thyroidal invasion were the risk factors for LNM(P<0.05),and no risk factor for skip LNM was found.Patients underwent central and lateral lymph node dissection had longer postoperative hospital stay than those without dissection or with central lymph node dissection only(P<0.05).Both parathyroid gland and recurrent laryngeal nerve injuries were temporary postoperatively.There were no differences in injury rate among three methods(P>0.05).The sensitivity,specificity,false negative rate,and false positive rate of high resolution ultrasonography for only lateral neck LNM were 95.0%,75.0%,5.0%,and 25.0%,repectively.The positive predictive value and negative predictive value were 90.5% and 85.7%,respectively.Conclusions Total thyroidectomy should be performed in patients with risk factors for LNM,and simultaneous central lymph node dissection is safe.High resolution ultrasonography is of great value in diagnosing skip LNM,and functional lymph node dissection also should be applied in patients who are highly suspected to have skip LNM.更多还原