甲状腺微小乳头状癌颈淋巴结转移危险因素分析及外科处理策略

Analysis of risk factors for cervical lymph node metastasis of thyroid micropapillary carcinoma and surgical processing strategies

目的探讨甲状腺微小乳头状癌(PTMC)颈淋巴结转移危险因素及外科处理策略。方法选取安徽医科大学附属六安医院2014年1月至2018年6月收治的PTMC病人106例作为研究对象,其中无淋巴结转移者64例,淋巴结转移者42例,包括中央区淋巴结转移者37例,侧颈部淋巴结转移者14例。收集所有研究对象年龄、性别、肿瘤直径、肿瘤位置、病灶情况、甲状腺包膜受侵情况等临床资料,分析甲状腺微小乳头状癌颈淋巴结转移危险因素,探讨外科处理策略。结果(1)中央区淋巴结转移危险因素:年龄、肿瘤直径、是否多灶、肿瘤位置、甲状腺包膜受侵情况与中央区淋巴结转移有关(P<0.05);多因素分析可知,肿瘤直径≥7 mm、双侧癌、多灶、包膜受侵是中央区淋巴结转移的独立危险因素(P<0.05);(2)侧颈区淋巴结转移危险因素:肿瘤直径、肿瘤位置、甲状腺包膜受侵情况、是否多灶与侧颈区淋巴结转移有关(P<0.05);多因素分析:肿瘤直径≥7 mm、包膜受侵、多灶、上极肿瘤是侧颈区淋巴结转移的独立危险因素(P<0.05)。结论对于PTMC病人而言,肿瘤直径≥7 mm、双侧癌、多灶、包膜受侵是中央区淋巴结转移的独立危险因素,肿瘤直径≥7 mm、包膜受侵、多灶、上极肿瘤是侧颈区淋巴结转移的独立危险因素,临床应根据上述对应独立危险因素判断淋巴结转移区域及危险程度,采取针对性外科处理措施,以改善预后情况。

Objective To study the risk factors and surgical management strategies of cervical lymph node metastasis in thyroid mi cropapillary carcinoma(PTMC).Methods A total of 106 patients with PTMC admitted to Lu’an Hospital Affiliated to Anhui Med ical University from January 2014 to June 2018 were enrolled.Among them,64 patients had no lymph node metastasis,42 patients had lymph node metastasis,including 37patients with central lymph node metastasis,and 14 cases of lateral cervical lymph nodes transfer.The clinical data of age,gender,tumor diameter,tumor location,lesion status,and thyroid capsule invasion were collected.The risk factors forcervical lymph node metastasis of thyroid micropapillary carcinoma were analyzed,and the surgical management strategy was discussed.Results(1)Risk factors of central lymph node metastasis were related to age,tumor diameter,multifocal,tumor location,thyroid capsule invasion and central lymph node metastasis(P<0.05);multivariate analysis showed that tumor diameter≥7 mm,bilateral cancer,multifocal,and capsule invasion were independent risk factors for central lymph node metastasis(P<0.05);(2)risk factors for lateral cervical lymph node metastasis were related to tumor diameter,tumor location,thyroid cap sule invasion,multifocal and lateral cervical lymph node metastasis(P<0.05);multivariate analysis:tumor diameter≥7 mm,cap sule invasion,multifocal,upper pole tumor were independent risk factors for cervical lymph node metastasis(P<0.05).Conclu sion For patients with PTMC,tumor diameter≥7 mm,bilateral cancer,multifocal,and capsular invasion are independent risk fac tors for central lymph node metastasis.Tumor diameter≥7 mm,capsular invasion,multifocal,and epithelial tumor are independent risk factors for lymph node metastasis in the lateral neck region.Clinically,the lymph node metastasis area and risk degree should be judged according to the above mentioned corresponding independent risk factors,and targeted surgical treatment measures should be taken to improve the prognosis.