【作者】 马林；

【导师】 孟宪瑛；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的：本文目的是探究影响Delphian淋巴结的转移情况的临床因素以及其预测意义，并且探究Delphian淋巴结转移规律对甲状腺乳头状癌临床诊疗的指导作用。方法：回顾性分析2013年9月到2015年1月就诊于吉林大学第一医院行手术治疗的探查到Delphian淋巴结并送检的182例术后石蜡病理确诊为甲状腺乳头状癌的病例，单因素分析研究相关临床因素（包括性别、年龄、肿瘤最大径，是否多灶，肿瘤是否侵犯甲状腺被膜、是否合并桥本甲状腺炎或结节性甲状腺肿或甲状腺腺瘤以及中央区气管旁淋巴结和侧颈淋巴结是否阳性）与Delphian淋巴结转移情况的相关关系，并对有统计学意义（P＜0.05）的临床因素进行logistic回归分析，进一步验证各临床因素的影响。对Delphian淋巴结的阳性个数与中央区气管旁淋巴结及侧颈淋巴结转移率做相关性分析，并研究Delphian淋巴结转移与肿瘤同侧及对侧Ⅵ区淋巴结转移情况的相关性。结果：本研究中Delphian淋巴结转移与年龄（P=0.005）、肿瘤最大直径（P＜0.001）、是否侵及被膜（P=0.003）以及是否合并桥本甲状腺炎（P=0.015）的差异有统计学意义（P＜0.05）；与其他临床特征差异没有统计学意义；多因素logistic回归分析示肿瘤最大直径大于1cm，侵及甲状腺被膜的P值分别为＜0.001、0.038，OR值分别为4.895、2.563，95%的可信区间分别为2.401~9.981、1.055~6.226；中央区气管旁淋巴结转移率与Delphian淋巴结转移的个数的Kendall相关系数与Spearman相关系数均为1.000，P＜0.01，侧颈淋巴结转移率与Delphian淋巴结转移个数Kendall相关系数为0.714，Spearman相关系数为0.739，P＜0.01；Delphian淋巴结阳性时患侧与对侧Ⅵ区的淋巴结转移率均较高（P＜0.05）。结论：Delphian淋巴结的转移与患者年龄、肿瘤直径、是否侵犯被膜及被膜外组织以及是否合并桥本甲状腺炎等因素有关，肿瘤直径大于1cm、侵犯甲状腺被膜是Delphian淋巴结转移的危险因素；Delphian淋巴结阳性时中央区气管旁淋巴结和侧颈淋巴结转移率分别是Delphian阴性的3倍和1.5倍，并且转移率均与Delphian淋巴结的阳性个数呈正相关；Delphian淋巴结阳性癌灶同侧及对侧Ⅵ区的转移率均较高。更多还原

【Abstract】 Objective: The objective of this study was to determine the incidenceand significance of delphian lymph node metastasis in papillary thyroidcancer and to evaluate the clinical significance of delphian lymph nodemetastasis in patients with papillary thyroid cancer.Methods: This paper reviewed the medical records of182patients withpathologically confirmed papillary thyroid carcinoma who underwentthyroid surgery and was detected delphian lymph node betweenSeptember2013and January2015in the No.1Hospital of JilinUniversity. The relationship between related clinical factors and thedelphian lymph node metastasis is analyzed, such as sex, age, biggestdiameter of tumor, multicentricity, capsule invasion, concomitantHashimoto’s thyroiditis, concomitant nodular goiter, concomitantthyroid adenoma, central metastasis and lateral metastasis. The clinicalfactors of statistical significance were analyzed by logistic regressionanalysis, and were to further validate effect. Correlation analysis wascarried between positive number of delphian lymph node and centralparatracheal lymph node and lateral metastasis, the relationship betweendelphian lymph node metastasis and ipsilateral or contralateral LevelⅥ lymph node metastasis. Results: The difference was statistically significant in the study ofdelphian lymph node metastasis and age（P=0.005）、biggest diameter oftumor（P＜0.001）、capsule invasion（P=0.003）and concomitantHashimoto’s thyroiditis（P=0.015）, there was no significant differencewith other clinical features. Multivariate logistic regression analysisshowed that biggest diameter of tumor＞1cm and capsule invasionP-value respectively to be＜0.001、0.038，OR4.895、2.563，95%CIfor EXP2.401~9.981、1.055~6.226；The central paratracheal lymphnode metastasis rate and the number of delphian lymph node metastasisKendall correlation coefficient and Spearman correlation coefficientwas1, P <0.01, lateral cervical lymph node metastasis rate and thenumber of delphian lymph node metastasis Kendall correlationcoefficient is0.714, the Spearman correlation coefficient was0.739,P<0.01; positive lymph nodes with delphian the transfer rate is higherand the contralateral level Ⅵ lymph node (P <0.05).Conclusion: Delphian lymph node metastasis is related with the factorsof age, biggest diameter of tumor, capsule invasion, concomitantHashimoto’s thyroiditis. Tumor size larger than1cm and capsuleinvasion are the danger factors of delphian lymph node metastasis.When delphian lymph node metastasis is detected, patients were3.0times more likely to have further central compartment metastasis and1.5times to have lateral compartment metastasis. And metastasis rate are positive related with the number of metastatic delphian lymph node.When patients are with single side involved and metastatic delphianlymph node, the metastasis rate of affected side and opponent Level Ⅵis higher.更多还原