甲状腺微小乳头状癌颈淋巴结转移影响因素的初步研究（附1180例报道）

Effective factors of cervical lymph node metastasis of papillary thyroid microcarcinoma （ 1 180 cases ）

目的探讨甲状腺微小乳头状癌颈淋巴结转移规律及影响因素，为淋巴结清扫指征及范围的选择提供理论依据。方法回顾分析吉林大学中日联谊医院2008年6月-2011年12月初次治疗的1180例甲状腺微小乳头状癌患者的临床信息及病理资料，总结颈淋巴结转移规律及影响因素。结果1180例甲状腺微小乳头状癌颈淋巴结转移率为29．6％，中央区及侧颈转移率为26．4％、15．2％。男性与女性中央区转移率分别为44．9％、21．8％（P〈0．05）；侧颈转移率为39．8％、9．0％（P〈0．01）。≤45岁与〉45岁患者中央区转移率为30．3％、17．9％（P〈0．05）。肿瘤D≤0．5cm与0．5cm〈D≤1cm中央区转移率为20．2％、33．2％（P〈0．05）。单灶与多灶中央区转移率为15．7％、45．0％（P〈0．01）。肿瘤未侵犯包膜与侵犯包膜侧颈淋巴结转移率为14．2％、44．4％（P〈0．05）。中央区淋巴结未转移而发生侧颈转移率为4．3％，中央区发生转移伴侧颈转移率为45．5％（P〈0．01）。结论甲状腺乳头状癌颈淋巴结转移在男性、低龄、多灶、肿瘤长径较大及肿瘤外侵的患者中更多见。在制定淋巴结清扫指征及范围时，应充分评估影响淋巴结转移的高危因素，实施个体化的清扫策略。

Objective To discuss the effective factors and metastasis rules of cervical lymph node of pa- pillary thyroid microcarcinoma, aimed to provide references for indications and range of lymph node dissec- tion. Methods Reviewed the clinical information and pathological material of primary treatment of 1 180 cases of papillary thyroid microcarcinoma patients in China-Japan Union Hospital of Jilin University from June 2008 to Decenlber 2011 by retrospective analysis, luther summared cervical lymph node metastasis rules and effective factors. Results The lymph node metastasis rate of 1 180 patients with papillary thyroid mi- crocarcinoma was 29.6% , which of these of the central and lateral region were 26.4% and 15.2%. Central region lymph nodes metastasis rates in male and female were respectively 44.9% , 21.8%o （ P 〈 0.05 ） , and were 39.8% , 9.0% in lateral region（P 〈0.01 ）. Lymph node metastasis rates of patients whose age~〈45 years old and 〉 45 years old were 30.3% , 17.9% （P 〈 0.05）. The lymph mode metastasis rate which di- ameter of tumour（D） ~〈0.5 cm or 0.5 c m 〈 D ~ 1 cm in central region were 20.2%, 33.2% （ P 〈 0.05 ）. The lymph node metastasis rate of single and more nidi respectively were 15.7% , 45.0% in central region. The lymph node metastasis rate of tumors invasion or not were 44.4% and 14.2% in central region （ P 〈 0.05 ）. The metastasis rates were 45.5% and 4.3% in the lateral region when the lymph node infringe or not in central region. Conclusions Lymph node metastasis happens relatively more common in papillary thyroid microcarcinoma patients with the factors such as male, young age, multiple nidi, long diameter of tumor and invasion of tumor envelope. So when doctors establish the indications and range of lymph node dissection, it＇ s need to pay attention to the high risk factors seriously which effect lymph node metastasis of papillary thyroid carcinoma, and establish the lymph node dissection strategy individually.