甲状腺乳头状微小癌合并桥本甲状腺炎颈部淋巴结转移相关因素分析

Predictive factors for lymph node metastasis in papillary thyroid microcarcinoma with Hashimoto's thyroiditis

目的探讨甲状腺乳头状微小癌(PTMC)合并桥本甲状腺炎的临床病理特点与颈部淋巴结转移之间的关系。方法分析2007年6月至2015年9月徐州医科大学附属医院收治的41例PTMC患者资料,组织病理证实同时合并桥本甲状腺炎。结果 41例患者中,12例出现中央区淋巴结转移,中央区淋巴结转移与性别、肿瘤大小、甲状腺包膜侵犯以及颈侧区淋巴结转移有关(P<0.05)。3例行术前彩超引导下淋巴结细针穿刺,1例组织病理证实为甲状腺癌淋巴结转移,行颈侧区淋巴结清扫,术后常规病理证实为甲状腺癌淋巴结转移。5例出现颈侧区淋巴结转移,颈侧区淋巴结转移与甲状腺包膜侵犯以及中央区淋巴结转移相关(P<0.05)。结论 PTMC合并桥本甲状腺炎可伴有中央区淋巴结转移,应常规行中央区淋巴结清扫;对于术前检查发现颈侧区肿大淋巴结可疑恶性者,可行彩超引导下细针穿刺活检,避免颈侧区淋巴结清扫带来的相关术后并发症。

Objective To analyze the clinical and pathological predictive factors for lymph node metas- tasis in papillary thyroid microcarcinoma （PTMC） with Hashimoto＇s thyroiditis （HT）. Methods From June 2007 to September 2015, clinical data of 41 patients with PTMC from The Affiliated Hospital of Xuzhou Medical College, who were confimed with Hashimoto thyroiditis by pathology, were reviewed. Results Of the 41 pa- tients, 12 patients had central lymph node metastasis, which was significantly related to sex, tumor size, thyroid capsular invasion and lateral lymph node metastasis （ P 〈 0. 05 ）. Three cases received preoperative fine needle aspiration cytology of lateral lymph node. Of the three cases, one was thyroid cancer lymph node metastasis con- firmed by pathology, and lymph node dissection was performed in the lateral cervical region. There were five ca- ses with lateral lymph node metastasis, which was significantly related to thyroid capsular invasion and central lymph node metastasis （P 〈 0. 05 ）. All patients accepted follow-up, without metastasis, recurrence or death. Conclusions The central lymph node dissection is advoted in cases of PTMC with HT, which is associated with central lymph node metastasis. The prognosis is good. If the preoperative examinations show lateral lymph nodes, according to the result of fine needle aspiration cytology of lateral lymph node, we can formulate corre- sponding treatment plan to avoid postoperative complications of lateral lymph node dissection.