目的：研究和分析甲状腺乳头状癌颈部淋巴结转移的分布规律及其相关因素。方法：回顾性分析笔者所在医院2013年8月-2015年2月收住入院并接受手术治疗的178例甲状腺乳头状癌患者的临床资料，分析其颈清扫术后淋巴结转移的分布情况及与患者年龄、性别、肿瘤大小、原发灶包膜浸润等因素的相关性。结果：不同颈部分区转移淋巴结转移率比较差异有统计学意义(P<0.01)，其中以Ⅵ区转移率最高，达51.30%。患者年龄大于45岁、伴多灶病变、Ⅵ区淋巴转移3枚以上及原发灶包膜浸润的患者其淋巴结转移率较高(P<0.05)，进一步多因素Logistic回归分析结果表明，原发灶包膜浸润是甲状腺乳头状癌颈部淋巴结转移的独立危险因素(P<0.05)。结论：甲状腺乳头状癌颈部淋巴结转移多集中于Ⅵ区，其次是Ⅲ区，行颈清扫术时应着重清扫Ⅵ区；原发灶包膜浸润是甲状腺乳头状癌颈部淋巴结转移的独立危险因素，可作为临床上对患者是否施行预防性颈部淋巴结清扫术的辅助判断指标。%Objective:To analyze the distribution and related factors of the cervical lymph node metastases of thyroid papillary carcinoma. Method:The clinical data of 178 cases of thyroid papillary carcinoma patients who underwent surgery in our hospital from August 2013 to February 2015 were reviewed retrospectively.The correlation between the distribution of lymph node metastasis and patients’ age,gender,tumor size,primary focal capsular invasion were analyzed.Result:The proportion of lymph node metastases of different partition had statistically significant difference(P<0.01).InⅥzone,the transfer rate was the highest to 51.30%.The rates of lymph node metastases in patients who were older than 45 years,with multifocal lesions,lymph node metastases in Ⅵregion more than three and with primary focal capsular invasion were higher(P<0.05).Moreover,multifactorial Logistic regression analysis results showed that the primary focal capsular invasion of thyroid papillary carcinoma was a independent risk factor for cervical lymph node metastases(P<0.05).Conclusion:The cervical lymph node metastases of thyroid papillary carcinoma is more focused on theⅥandⅢzone,so clinical neck dissection shall focus on cleaning these partitions especially theⅥzone. In addition,primary focal capsular invasion as the independent risk factor for cervical lymph node metastases of thyroid carcinoma can be a indication to judge whether lymph node metastases exists.
展开▼
