1358例甲状腺结节的临床与病理特征分析

Clinical and pathological analysis of 1358 patients with thyroid nodules

目的分析甲状腺结节的临床与病理特征,寻找甲状腺癌诊断及其发生淋巴结转移的可能因素。方法行手术治疗的甲状腺结节患者1358例,对其年龄、性别、高血压和甲亢病史、癌灶大小、双侧癌、多灶癌、浸润包膜及合并桥本甲状腺炎等特征进行统计学分析。结果 1358例患者中,女性患者占大多数(约80.3%),45岁以上患者占70.0%。其中,264例为甲状腺癌。对良恶性结节患者进行临床特征分析后发现,年龄及高血压病史与恶性结节的发生相关(P<0.05),年龄<45岁为甲状腺癌的独立危险因素。所有甲状腺癌患者中,37.5%的患者有颈部淋巴结转移,其发生与年龄、高血压、癌灶大小和浸润包膜相关(P<0.05),而年龄<45岁和癌灶浸润包膜为甲状腺癌发生颈部淋巴结转移的独立危险因素,在甲状腺乳头状癌患者中也同样如此。结论对于年龄<45岁的甲状腺结节患者怀疑甲状腺癌者应密切观察或早期干预,对其中癌灶浸润包膜者给予颈部淋巴结清扫,可能让患者获得更好的预后。

Objective To analyze the clinical and pathological characteristics of thyroid nodules, so as to search for the possible factors that may be related to the occurrence of thyroid cancer lymph node metastasis. Methods We retrospectively studied 1358 patients with thyroid nodules operated in Renmin Hospital of Wuhan University from January 2011 to December 2012. Clinical data on age, sex, history of hypertension（HBP） or hyperthyroidism and pathological data on bilateral, multifocal or capsule invasion of thyroid cancer and whether or not accompanying with Hashimoto＇s thyroiditis were statisticaUy analyzed. Results Of the 1358 involved patients, female patients took the majority （80.3 % ）, and 70.0% were un- der the age of 45 years old. Among them, 264 cases were diagnosed as thyroid cancer. Besides, age and history of hypertension were associated with the occurrence of malignant nodules（ P 〈0.05 ） ,and the age of less than 45 years old was an independent risk factor for thyroid cancer. The clinical and pathological characteristics of thyroid cancer were analyzed as well. The results showed that 37.5% of the patients had cervical lymph node metastasis, which was associated with age, history of hypertension, tumor size and cap- sule invasion（P 〈 0.05 ）. Age under 45 years old and capsule invasion were found to be independent risk factors of cervical lymph node metastasis in both thyroid cancer, especially in papillary thyroid cancer. Conclusion Patients with thyroid nodules under the age of 45 years old should be closely followed up or treated in a short term, and total thyroidectomy plus lymph node dissection may be a safe therapeutic ap- proach for the thyroid cancer patients with capsule invasion.