乳头状甲状腺癌颈淋巴结转移方式及其相关影响因素的研究

Pattern and Predictive Factors of Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma

目的评估乳头状甲状腺癌（PTC）颈淋巴结的转移方式及相关影响因素在颈部不同区域淋巴结转移中的意义。方法回顾性分析笔者所在医院甲状腺外科2008年12月至2011年12月3年期间行手术治疗的223例PTC患者的临床资料，就患者性别、年龄、术前TSH水平、肿瘤直径、是否为多灶、是否侵及甲状腺被膜及其周围组织、是否合并桥本甲状腺炎、是否合并结节性甲状腺肿以及肿瘤的T分期等因素与颈部不同区域的淋巴结转移之间的关系进行分析。结果单变量分析结果显示，年龄≥45岁及合并结节性甲状腺肿与中央区淋巴结转移有关（P〈0．05），多发病灶与颈侧区淋巴结转移有关（P〈0．05）；多变量分析结果显示，年龄≥45岁及合并结节性甲状腺肿是中央区淋巴结转移的保护因素（P〈0．05），多发病灶是颈侧区淋巴结转移的危险因素（P〈0．05）。Ⅱ-Ⅳ区是颈侧区淋巴结转移的常见区域，其中Ⅲ区转移率最高，达100％；当出现跳跃性转移时，Ⅱ-Ⅳ区是转移高发区域。结论对年龄〈45岁的PTC患者应常规进行中央区淋巴结清扫；如果患者同时合并结节性甲状腺肿，中央区淋巴结转移的风险会显著降低；当原发肿瘤为多发病灶时，应加强术中对Ⅱ-Ⅳ区淋巴结的探查，尤其是Ⅲ区淋巴结；当可疑跳跃性转移出现时，Ⅱ-Ⅳ区淋巴结应是常规清扫范围。

Objective To evaluate the pattem and predictive factors of regional lymph node metastasis in papillay thyroid carcinoma （PTC）. Methods The clinical data of 223 patients with PTC whom suffered operation from Dec. 2008 to Dec. 2011 in our hospital were retrospective analyzed. The relationship among the lymph node metastasis of different area of the neck and patient＇s sex, age, preoperative TSH level, tumor size, multifocality, extracapsular spread, Hashimoto thyroiditis, nodular goiter, and the T classification of the tumors were analyzed. Results The univariate analysis results showed that patient＇s age ≥ 45 years old and associated with nodular goiter were statistically significantly related to central lymph node metastasis （P〈0. 05）, for lateral lymph node metastases, the multifocality were statistically significant （P〈 0. 05）. The multivariate analysis results showed that patient＇s age ≥ 45 years old and associated with nodular goiter were protective factors for central lymph node metastasis （P〈0.05）, for lateral lymph node metastasis, the multifocality was risk factor （P〈0. 05）. Most of the lateral lymph node metastases were confined to levels Ⅱ-Ⅳ, and the incidence of level Ⅲ was as highest as 100%. When the skip metastasis, the levels Ⅱ-Ⅳ were the transfer of high incidence areas. Conclusions When age 〈 45 years old of patients with PTC, the central neck dissection should be routine performed. The incidence of central lymph node metastasis will decrease if associated with nodular goiter. Because multifocality is a risk factor for lateral lymph node metastasis, careful inspection levelsⅡ-Ⅳ should be performed during operation, espe-cially level Ⅲ lymph nodes. If skip metastasis is present, levelsⅡ-Ⅳdissection would be a proper treatment option.