甲状腺乳头状癌Ⅱb区淋巴结转移规律初探

摘要

目的 分析影响甲状腺乳头状癌患者颈部Ⅱb区淋巴结转移的相关因素.方法 回顾性分析2011年1月至2012年12月63例甲状腺乳头状癌伴颈淋巴结转移患者临床资料,63例患者的颈淋巴清扫标本67侧按颈部分区计数淋巴结数目,研究患者年龄,性别,原发灶肿瘤大小,肿瘤部位,是否多发病灶、甲状腺被膜受侵、合并淋巴细胞性甲状腺炎或被膜受侵,以及病理T3和T4a分期,转移淋巴结在颈部分区分布,淋巴结有无融合等与Ⅱb区淋巴结转移的相关性.采用SPSS 14.0软件对数据进行分析.结果 41例甲状腺肿瘤最大直径＞1.0 cm,26例肿瘤位于甲状腺上1/3,39例肿瘤为多发病灶,54例肿瘤侵犯甲状腺被膜,病理T3和T4a期54例,15例合并淋巴细胞性甲状腺炎.Ⅱb区淋巴结转移12侧(17.9％),Ⅱa、Ⅲ、Ⅳ、Ⅴ、Ⅵ区淋巴结转移分别为38侧(56.7％)、58侧(86.6％)、46侧(68.7％)、15侧(22.4％)、58侧(86.6％),Ⅱa+Ⅲ区转移35侧(52.2％),Ⅲ+Ⅳ区转移37侧(55.2％),Ⅱa+Ⅲ+Ⅳ区转移25侧(37.3％).38侧Ⅱa区淋巴结转移中10侧Ⅱb区淋巴结转移(26.3％),29侧无Ⅱa区转移中2侧(6.9％)Ⅱb区淋巴结有转移.单因素分析显示Ⅱb淋巴结转移与Ⅱa区淋巴结转移相关(x2 =4.219,P=0.040).结论 甲状腺乳头状癌Ⅱb区淋巴结转移率较低,Ⅱa区淋巴结无转移者Ⅱb区淋巴结转移比率更低.Ⅱa区淋巴结无转移者是否可以不再清扫Ⅱb区,值得继续研究.%Objective To evaluate the factors related to level Ⅱ b lymph node (LN) metastasis in papillary thyroid carcinoma (PTC).Metholds The medical records of 63 PTC patients were reviewed.The patients underwent neck dissection (ND) between January 201 1 and December 2012,who were determined with pathologically lateral cervical LN metastasis.A toal of 67 ND specimens were obtained and analyzed for LN involvement with respect to neck levels.The ralation of level Ⅱ b LN metastasis with clinical factors,including age and sex of patients,tumor size,location,multifocality,extracapsular spread (ECS) and stage of primary PTC,coexistence of lymphocytic thyroiditis,distribution of metastasis LN in different levels,fusion and extracapsular invasion of LN were analyzed with univariate analysis and x2 test.SPSS 14.0 software was used to analyze the data.Results Of 63 patients,41 patients revealed thyroid tumor maximum diameter more than 1 centimeter,26 patients with tumor located in the upper 1/3 thyroid lobe,39 patients with multiplicity of thyroid tumor and 54 patients with ECS,54 patients with pathological T3/T4a stage,15 patients with coexisting lymphocytic thyroiditis.Among the 67 ND specimens,12 specimens (17.9％) showed level Ⅱb LN metastasis and the incidences of LN metastasis at level Ⅱ a,Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅱ a + Ⅲ,Ⅲ+Ⅳ,and Ⅱa+ Ⅲ +Ⅳ were 56.7％,86.6％,68.7％,22.4％,86.6％,52.2％,55.2％,37.3％,respectively.Of the 38 ND specimens with level Ⅱ a LN metastases,10 were positive in level Ⅱb (26.3％).But of 29 ND specimens without level Ⅱ a LN metastases,only 2 were positive in level Ⅱ b.A univariate analysis revealed that level Ⅱ a LN metastasis was a significant predictive factor for level Ⅱb LN metastasis (x2 =4.219,P =0.040).Conclusion The incidence of LN metastasis to level Ⅱ b is low in PTC,which is less when level Ⅱ a is not involved.