甲状腺乳头状癌术后超声引导下淋巴结穿刺195例的临床分析

Ultrasound-guided biopsy in lymph nodes of postoperative thyroid papillary carcinoma: a review of 195 patients

目的 分析甲状腺乳头状癌术后颈部复发、转移性淋巴结的超声表现,探讨超声引导下细针穿刺细胞学检查在甲状腺乳头状癌术后颈部淋巴结转移的应用价值。方法 收集我院甲状腺乳头状癌术后接受颈部淋巴结超声引导下细针穿刺的195例患者的资料,分析转移性淋巴结超声影像学特点与病理结果的关系。结果 195例患者中共277枚淋巴结接受穿刺检查,其中86例（123枚）淋巴结为转移性,占穿刺淋巴结的44.4%,复发或转移的淋巴结多分布于颈部Ⅲ区（33.3%）及Ⅳ区（42.3%）,超声特征性表现为长径/短径（L/S）比值小、回声分布不均匀、常伴有点状强回声、Adler血流分级2～3级,与非转移性淋巴结相比,差异有统计学意义（P〈0.01）。结论 甲状腺癌术后颈部转移性淋巴结具有特征性超声表现,超声引导下的颈部淋巴结细针穿刺细胞学检查是一种简便且安全有效的确诊手段,有助于指导患者的进一步治疗。

Objective To evaluate the clinical significance of uhrasound-gnided needle biopsy in diagnosis of lymph nodes recurrence and metastasis in postoperative thyroid papillary carcinoma. Methods We analyzed the ultrasonic features of 195 patients who received ultrasound-guided needle biopsy after thyroidectomy, and the influence of ultrasonic feature on pathological diagnosis was also studied. Results 277 cervical lymph nodes from 195 patients after thyroidectomy were studied. In 86 cases （123 iymph nodes）, metastasis was found （44.4%）, and a majority of metastatic iymph nodes was found located in Ⅲ ～ Ⅳ region, and appeared to have a long-to short-axis diameter ratio of less than 2. They showed maidistribution echo, always found calcification inside, and the blood flow was classified as degree 2 - 3. According to theuhrasonic characteristics above, metastatic iymph nodes significantly differed from non-metastatic ones （ P 〈 0. 01 ）. Conclusion Ultrasonography combined with FNAC is useful in diagnosis of cervical lymph node recurrence and metastasis in postoperative thyroid carcinoma.