【作者】 郑绪才； 王圣应； 张荣新； 任自学； 刘松； 陈公仆；

【Author】 Zheng xu-cai;Wang sheng-yin;zhang rong-xin;ren zi-xue;liu song;chengong-pu;Head and Neck Cancer Surgery,Anhui Cancer Hospital;

【机构】 安徽省肿瘤医院头颈肿瘤外科；

【摘要】 目的探讨甲状腺乳头状癌中央区及侧颈区淋巴结转移的相关因素,为临床选择合理的颈淋巴结清扫范围寻找依据。方法回顾性分析我院2012年3月至2014年3月资料完整的56例甲状腺乳头状癌患者的临床病理资料。每个病例至少行一侧侧颈区颈淋巴结清扫术,11例行中央区和侧颈区颈淋巴结清扫术。用x2检验对患者年龄、性别、癌灶部位、原发灶最大径、癌灶多发、肿瘤侵犯被膜外组织与中央区及颈侧区淋巴结转移情况进行单因素分析,用二分类Logistic回归对单因素分析中有统计学意义的指标进行多因素分析。结果 56例乳头状癌患者,中央区淋巴结转移率为32.1%(18/56),侧颈区淋巴结转移率为37.5%(21/56)。单因素分析发现肿瘤最大径(≥2cm)、甲状腺包膜或包膜外侵犯、侧颈区淋巴结阳性与中央区淋巴结转移显著相关(P<0.05);单因素分析发现肿瘤侵犯被膜外组织和发生中央区淋巴结转移、肿块位置与是否发生颈侧区淋巴结转移有显著相关性(P<O.05)。中央区和侧颈区淋巴结阳性率比较,差异有统计学意义(p<0.01)。多因素分析Logistic回归模型发现肿瘤部位、中央区淋巴结转移是影响侧颈区淋巴结转移的危险因素(P值分别为0.035、0.021)。多因素分析Logistic回归模型发现肿瘤侵犯被膜外组织、侧颈区淋巴结转移是影响中央区淋巴结转移的危险因素(P值分别为0.016、0.017)。结论肿瘤浸润甲状腺外组织及同侧侧颈区淋巴结转移是甲状腺乳头状癌患者中央区淋巴结转移的危险因素,肿瘤部位及中央区淋巴结转移是甲状腺乳头状癌患者侧颈区淋巴结转移的危险因素,对于甲状腺乳头状癌患者,肿瘤侵犯被膜外组织、肿块位于上级且伴有中央淋巴结转移,侧颈区应予以更积极的治疗方法。更多还原

【Abstract】 Objective To investigate the factors associated with papillary thyroid carcinoma central area between the side of the neck lymph node metastasis, choose the right neck lymph node dissection for clinical looking basis. MethodsRetrospective analysis of clinical data in our hospital from March 2012 to March 2014 with complete data of 56 cases of papillary thyroid cancer. Each case at least one side of the line side of the neck region neck dissection, 11 cases of central and lateral neck dissection neck area. By x2 test on the patient’s age, sex, tumor location, maximum diameter of the primary tumor, multiple foci, tumor invasion of the capsule outside the organization with the Central District and lateral neck lymph node metastasis univariate analysis, Logistic regression with two-on-one there were significant factors in multivariate analysis indicators. Result 56 cases of papillary carcinoma, central lymph node metastasis rate was 32.1%( 18 / 56), lateral cervical lymph node metastasis rate was 37.5%( 21/ 56). Univariate analysis showed that tumor size(≥ 2cm), thyroid outer or capsular invasion, lateral cervical lymph node-positive and lymph node metastasis in the central region was significantly associated(P <0.05); Univariate analysis showed that tumor invasion of the capsule outside the organization and the occurrence of central lymph node metastasis, tumor location and whether the occurrence of lateral neck lymph node metastasis was significantly correlated(P <O.05). Central and lateral cervical lymph node-positive rate, the difference was statistically significant(p <0.01). Logistic regression multivariate analysis found that tumor invasion capsule outside the organization, the Central District is a risk factor for lymph node metastasis in cervical lymph node metastasis side effects(P values were 0.035,0.021). Logistic regression multivariate analysis found that the tumor site, lateral neck lymph node metastasis risk factors is central lymph node metastasis(P values were 0.016,0.017).Conclusion Thyroid tumor invasion ipsilateral side of the neck outside the organization and are risk factors for lymph node metastasis in papillary thyroid carcinoma patients with lymph node metastasis in the central area, central tumor location and lymph node metastasis is a risk factor in patients with papillary thyroid carcinoma cervical lymph node metastasis side, for papillary thyroid carcinoma, tumor invasion capsule outside the organization, and accompanied by mass in the superior central lymph node metastasis, side neck area should be more aggressive treatment.更多还原