目的 探讨多灶性甲状腺微小乳头状癌(PTMC)的数量及总直径对中央组淋巴结转移(CLNM)的预测价值.方法 回顾分析经手术和病理证实的157例多灶性PTMC与653例单发甲状腺乳头状癌的临床和病理资料,按照瘤体个数(以单发、2-、3-、≥4-表示)及多发瘤体总直径(TTD)或单发瘤体直径(UTD)的大小分组,比较各组CLNM的差异;分析CLNM阳性和TTD大小的关系.结果 2-PTMC组、3-PTMC组和≥4-PTMC组CLNM阳性率均明显高于单发PTMC组,差异均有统计学意义(均P＜0.01);2-PTMC组、3-PTMC组CLNM阳性率均明显低于≥4-PTMC组,差异均有统计学意义(均P＜0.01);2-PTMC组和3-PTMC组CLNM阳性率比较差异无统计学意义(P＞0.05).TTD≤1.0cm组CLNM阳性率明显高于UTD≤1.0cm组,差异有统计学意义(P＜0.01);TTD＞1.0cm组和UTD＞1.0cm组、TTD≤1.0cm组CLNM阳性率比较,差异均无统计学意义(均P＞0.05).TTD大小与CLNM阳性之间差异无统计学意义(P＞0.05).结论 与UTD≤1.0cm组比较,TTD≤1.0cm组更容易出现CLNM阳性,且CLNM阳性与TT D大小无关;与单发PTMC比较,多发PTMC更容易出现CLNM阳性,提示临床医生在治疗多灶性PTMC患者时,应更积极地进行预防性中央组淋巴结清扫手术.%Objective To investigate the association of tumor number and total tumor diameter with central lymph node metastasis (CLNM) in patients with multifocal papillary thyroid microcarcinoma (PTMC).Methods The clinical and pathological data of 157 patients with multifocal PTMC and 653 patients with solitary thyroid papillary carcinoma were analyzed retrospectively.The cases were grouped according to the number of tumors and the total diameter (TDD) or unifocal tumors diameter (UTD),the relations between positive CLNM and PTMC lesion number,the TDD was analyzed.Results There was significant difference in positive CLNM between solitary tumor group and the multifocal tumor group (P＜0.05).There was significant difference in positive CLNM between TTD ≤1.0cm group and UTD ≤ 1.0cm group (P＜0.05).There was no significant difference in positive CLNM between TTD ≤ 1.0cm group and TTD＞1.0cm group (P ＞0.05).Conclusion Central lymph node metastases are likely to occur in patients with multifocal TPMC and with larger total tumor diameter,indicating that for these patients more active dissection is necessary.
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