【作者】 李艳华；

【导师】 谢林；

【作者基本信息】 吉林大学 ， 公共卫生， 2012， 硕士

【摘要】 目的：甲状腺乳头状癌极易转移至颈部淋巴结，目前，国内外关于甲状腺癌颈部淋巴结转移特点的研究较少，而与临床病理特征之间的关系研究更少，特别是在临床颈部淋巴结阴性的患者中是否有哪些指标提示有淋巴结转移，这也是我们研究的目的之一。目前对于甲状腺乳头状癌原发灶切除范围国内外已基本趋于一致，然而，对于淋巴结的清扫范围特别是颈部淋巴结阴性者，尚未达成统一观点。本文通过对中央区及侧颈区淋巴结转移情况与临床病理特征相关性进行分析，并分析此二者之间相关性，旨在更深入了解颈部淋巴结转移特征，为临床医生合理的选择手术清扫范围提供客观依据。方法：收集吉林大学第一医院2008.01~2010.07实施甲状腺癌根治术同时行颈部中央区淋巴结清扫术的329例（其中同时行侧颈部淋巴结清扫115例）患者临床病理资料，分析中央区淋巴结及侧颈部淋巴结转移与临床病理资料的相关性。我们进一步对其中临床颈部淋巴结阴性患者的中央区及侧颈部临床病理资料相关性进行分析。结果：329例患者年龄14~76岁，平均年龄43岁；男性66例，女性263例；最大肿瘤5.5cm，最小0.1cm，平均1.11cm；肿瘤个数1~7个，平均1.76个；双侧癌97例，单侧癌232例；329例中央区转移145，转移率44.07%，同时行侧颈部淋巴结清扫115例，66例转移，转移率57.39%；临床中央区淋巴结阴性262例，淋巴结转移92例，转移率35.11%，临床侧颈部淋巴结阴性59例，淋巴结转移17例，转移率28.81%。经统计分析发现：1.甲状腺乳头状癌中央区淋巴结在男性、＜45岁、侵及甲状腺被膜及被膜外、＞1cm、不伴结节性甲状腺肿组中转移率更高，并且超声提示阳性者淋巴结转移率明显高于超声未提示转移组。与其他临床病理特征之间未见明显联系。经logstic回归分析，具有侵袭性、超声提示淋巴结转移是中央区淋巴结转移的危险因素。2.甲状腺乳头状癌侧颈部淋巴结在男性、＜45岁、＞1cm、单侧癌组中转移率更高，并且中央区淋巴结阳性者侧颈部淋巴结转移率明显高于中央区淋巴结阴性组。与其他临床病理特征之间未见明显联系。经logstic回归分析，中央区淋巴结转移是侧颈区淋巴结转移的危险因素。3.甲状腺乳头状癌临床中央区淋巴结阴性淋巴结转移情况在＞1cm、不伴结节性甲状腺肿组中转移率更高。与其他临床病理特征之间未见明显联系。4.甲状腺乳头状癌临床侧颈部淋巴结阴性淋巴结转移情况在中央区淋巴结阳性者侧颈部淋巴结转移率明显高于中央区淋巴结阴性组。与其他临床病理特征之间未见明显联系。结论：1.首次手术在切除原发灶的同时应行预防性中央区淋巴结清扫术。2.对于侧颈部淋巴结的处理，术前临床检查提示有转移者可以行侧颈部淋巴结清扫术，若术前临床检查未提示淋巴结转移可定期复查，暂不行预防性侧颈部淋巴结清扫。3.中央区淋巴结转移与侧颈部淋巴结转移有相关性，对于中央区淋巴结转移者应同时行侧颈部淋巴结清扫。4.术前超声检查对于颈部淋巴结清扫范围的选择有指导意义。更多还原

【Abstract】 [Objective] Papillary thyroid carcinoma can easily be transferred to the neck lymphnodes. At present, the research on the cervical lymph node metastases in thyroid cancer isRare.And the relationship between the clinicopathological features and Lymph nodemetastasis is less.Especially whether there are indicators which suggest a lymph nodemetastasis in those patients with clinically negative lymph nodes metastasis. This is also oneof the purposes of our study. At present, The scope of research of primary tumor for papillarythyroid carcinoma has reached consensus at home and abroad. However, lymphnode dissection for cervical lymph node negative patients, has not yet reached a consensus. Inthis study, the central region and lateral neck lymph nodes metastasis and clinicopathologicfeatures were analyzed, and the correlation between were also analyzed, in order to betterunderstand the characteristics of cervical lymph node metastasis, and provide an objectivereasonable choice basis of surgical treatment cervical lymph node for the Clinical surgery.[Methods] All patients from January2008to July2010in our hospital were collected,329cases of resection of thyroid cancer and central region lymph node dissection treatment ofPTC were analyzed (Including115cases of lateral cervical lymph nodes dissection at thesame time). We then analyzed the Correlation between the central region lymph node andlateral cervical lymph node metastasis and clinicopathological features. Further We thenanalyzed the Correlation between the central region lymph node and lateral cervical lymphnode metastasis and clinicopathological features in Clinical cervical lymph node-negativePatients.[Result] The329cases of patients aged14to76, the average age was43; male66cases,female263cases; The largest tumor was5.5cm, minimum0.1cm, average1.11cm; thenumber of tumors1-7, average1.76;97cases of bilateral,232cases of unilateral;145casesof central region lymph node metastasis in329, the metastasis rate44.07%,66cases of lateralcervical lymph node metastasis in115, the metastasis rate57.39%;92cases of central regionlymph node metastasis in262cases of Clinical central lymph node-negative Patients, themetastasis rate35.11%,17cases of lateral lymph node metastasis in59cases ofClinical lateral cervical lymph node-negative Patients, the metastasis rate28.81%.1.Papillary thyroid carcinoma those who were in the groups of male,＜45years old，associatedwith extrathyroidal invasion， the diameter>1cm, not associated with nodular goiter had ahigher rate of central region lymph node metastasis. And the group thatUltrasonography showed lymph node metastasis had a higher rate of central region lymphnode metastasis than the group that Ultrasonography did not show metastasis. There were noother associations between central region lymph node metastasis and other clinicopathologicalparameters. Logistic regression analysis showed extrathyroidal invasion andUltrasonography showed lymph node metastasis were risk factors for central region lymphnode metastasis.2. Papillary thyroid carcinoma those who were in the groups of male,＜45years old，unilateral tumor had a higher rate of lateral cervical lymph node metastasis. And thegroup of central region lymph node metastasis had a higher rate of lateral cervical lymph nodemetastasis than the group of without central region lymph node metastasis. There were noother associations between lateral cervical lymph node metastasis and otherclinicopathological parameters. Logistic regression analysis showed central region lymphnode metastasis was a risk factors for lateral cervical lymph node metastasis.3.Thoseclinically negative central lymph nodes metastasis papillary thyroid carcinoma who were inthe groups of the diameter>1cm, not associated with nodular goiter had a higher rate ofcentral region lymph node metastasis. There were no other associations between lateralcervical lymph node metastasis and other clinicopathological parameters.4. Thoseclinically negative lateral cervical lymph node metastasis papillary thyroid carcinoma who inthe group of central region lymph node metastasis had a higher rate of lateral lymph nodemetastasis than the group of without central region lymph node metastasis. There were noother associations between lateral cervical lymph node metastasis and otherclinicopathological parameters.[Conclusion]1. For papillary thyroid cancer，the most common cervieal lymph nodemetastasis is central region．It is necessary to dissect central region lymph node following theoriginal surgical procedure.2. If preoperative clinical examination demonstrate lateral cervicallymph node metastasis,we should practice lateral cervical lymph node dissection;Ifpreoperative clinical examination did not demonstrate lateral cervical lymph nodemetastasis,we should practice periodically review instead of lymph node dissection.3. Therewas significant association between central region lymph node metastasis and lateral cervicallymph node metastasis. It is necessary to dissect lateral cervical lymph node in the cases of central region lymph node metastasis.4. Ultrasound examination could guide the choice forneck lymph node dissection.更多还原