甲状腺乳头状癌超声表现与侧颈区淋巴结转移间关系的研究

Exploration of the relationship between ultrasonographic features of papillary thyroid carcinoma and lat-eral cervical lymph node metastasis

目的：研究甲状腺乳头状癌（ Papillary thyroid carcinoma ，PTC）高频超声表现与侧颈区淋巴结转移（ Lateral cervical lymph node metastasis ，LCLNM）间的关系。方法对449例患者的633个PTC结节进行分组。有LCLNM的为转移组，有91例患者共135个结节；无LCLNM的为无转移组，有358例患者共498个结节。所有结节的病理及有无LCLNM、颈中央区淋巴结转移（ Central cervical lymph nodule metasta-sis，CCLNM）均以术后病理诊断为金标准。用χ^2检验进行单因素分析，Logistic回归进行多因素分析。结果单因素分析显示男性、年龄＜45岁、多发、直径＞1 cm、微钙化多发（ d＜2 mm）、混合型血流（内部及边缘血流增多）、纵横比＜1、CCLNM、侵犯甲状腺包膜均与LCLNM相关（P＜0．05），PTC位于上极易发生LCLNM（P＜0．017）。多因素分析显示微钙化多发、纵横比＜1、CCLNM、侵犯甲状腺包膜和结节位于甲状腺上极同时出现是LCLNM的危险因素（P＜0．005，OR＝1．626，2．644，0．479，2．579）。结论高频超声可精确描述甲状腺癌结节声像图表现，这些表现对术前提示侧颈区有无侧颈区颈部淋巴结转移具有重要价值，可为临床手术及治疗提供更多信息。

Objective To investigate the relationship between ultrasonographic features of papillary thy-roid carcinoma（PTC）and lateral cervical lymph node metastasis （LCLNM）.Methods A total of 449 eligible ca-ses with 633 PTC nodules was selected and divided into two groups：LCLNM group included 135 nodules（91 pa-tients）;Without metastatic groups included 498 nodules（135 patients）.Ultrasonographic features of PTC nodules and the relationship with LCLNM were analyzed by χ^2 test and logistic regression analysis .Results In univariate analysis,the significant factors were male,age＆lt;45yrs,multifocal,maximal diameter（d＆gt;1 cm）,multi-microcal-cificaltion（d＆lt;2 mm）,mixed flow,wider than tall,CCLNM,extrathyroid extension,located in upper（P＆lt;0.05 or P＆lt;0.017）.Multivariate analysis showed that multi -microcalcificaltion（d＆lt;2 mm）,wider than tall,CCLNM,ex-trathyroid extension,located in upper pole were predictive factors of LCLNM （P＆lt;0.005,OR=1.626,2.644, 0.479,2.579）.Conclusion High-frequency ultrasound can accurately describe the sonographic appearance of thyroid nodules;it can be used to remind the risk of LCLNM before operation ,and will be informative for the treat-ment of surgery .