甲状腺微小癌颈淋巴结转移危险因素分析及手术范围的探讨

Analysis of risk factors for cervical lymph node metastasis and the scope of surgical dissection in thyroid microcarcinoma

目的:探讨影响甲状腺微小癌(TMC)颈淋巴结转移的危险因素以及颈淋巴结清扫的范围。方法:回顾性分析2009年1月—2013年6月收治的269例TMC患者资料,患者均在原发灶根治的同时行中央区淋巴结清扫,27例患者行颈侧区淋巴结清扫,分析患者各临床病理因素与颈淋巴结转移的关系。结果:269例患者中107例(39.8%)发生颈淋巴结转移,其中中央区淋巴结转移103例(96.3%),颈侧区淋巴结转移25例(23.4%)。单因素分析显示,男性、肿瘤直径>5.0 mm、包膜侵犯与TMC颈淋巴结转移有关(均P<0.05);多因素分析显示,肿瘤直径>5.0 mm(OR=3.358,P<0.05)、包膜侵犯(OR=5.230,P<0.05)是颈淋巴结转移的独立危险因素。结论:对于肿瘤直径>5.0 mm或有包膜侵犯的TMC患者,中央区淋巴结转移的几率增加,行中央区淋巴结清扫是必要的。

Objective： To determine the risk factors for cervical lymph node metastasis and the scope of lymph node dissection in thyroid microcarcinoma（TMC）.Methods： The clinical data of 269 TMC patients admitted from January 2009 to June 2013 were retrospectively analyzed. Of the patients, all cases underwent primary lesion resection plus central lymph node dissection and 27 cases underwent lateral cervical dissection. The relations of each clinicopathologic factor of the patients with cervical lymph node metastasis were analyzed. Results： Among the 269 patients, 107 cases（39.8%） had cervical lymph node metastasis, of whom 103 cases（96.3%） had central lymph node metastasis and 25 cases（23.4%） had lateral cervical lymph node metastasis. Univariate analysis showed that male sex, tumor size〉 5.0 mm and extrathyroidal invasion were significantly associated with cervical lymph nodes metastasis of TMC（all P〈0.05）; multivariate analysis identified that tumor size 〉5.0 mm（OR=3.358, P〈0.05） and extrathyroidal invasion（OR=5.230, P〈0.05） were independent risk factors for cervical lymph nodes metastasis. Conclusion： In TMC patients with tumor size 〉5.0 mm or extrathyroidal invasion, the incidence of central lymph node metastasis is increased and, in these cases, central lymph node dissection is necessary.