cNO期甲状腺微小乳头状癌中央区淋巴结转移的危险因素及预防性清扫的临床分析

Clinical analysis of risk factors for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and preventive dissection

目的 探讨临床颈淋巴结阴性（cN0期）甲状腺微小乳头状癌中央区淋巴结转移的临床特点及预防性清扫的意义及可行性，为临床治疗提供参考。方法 回顾性分析2011年7月-2015年12月在连云港市东方医院普外科接受手术的277例cN0期甲状腺微小乳头状癌患者的临床资料，评估预防性中央区淋巴结清扫的必要性，采用χ^2检验及Logistic回归分析中央区淋巴结转移与患者的性别、年龄、肿瘤数目、肿瘤大小、包膜浸润、单双侧肿瘤的关系。277例患者全部行原发灶根治性切除加患侧中央区淋巴结清扫术，清扫标本送检常规病理检查。结果 甲状腺微小乳头状癌中央区淋巴结转移阳性率为36.8%（102/277），在男性患者（P=0.023）、年龄〈45岁（P〈0.001）和肿瘤直径〉0.5 cm（P=0.019）中阳性率高；通过多变量分析可以表明男性患者（OR=2.63,P〈0.001）、年龄〈45岁（OR=2.25,P=0.016）、肿瘤直径〉0.5 cm（OR=2.13,P=0.009）均能独立作为CLN转移的危险因素。15例（5.4%）出现暂时性喉返神经麻痹，43例（15.5%）出现暂时性甲状旁腺功能低下，无永久性喉返神经麻痹和甲状旁腺功能低下并发症患者。结论 预防性中央区淋巴结的清扫有助于准确进行肿瘤的分期分级以及危险度的评估，对患者术后治疗随访方案的选择有重要意义，对于男性、年龄〈45岁、肿瘤直径〉0.5 cm、有包膜浸润的患者应常规行中央区淋巴结清扫。

Objective To discuss the clinical characteristics for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and significance and feasibility of preventive dissection, aimed to provide reference for clinical treatment. Methods Reviewed the clinical data of 277 patients with stage cN0 papillary thyroid microcarcinoma from Jul. 2011 to Dec. 2015 underwent surgery in the Department of General Surgery of Lianyungang East Hospital. Evaluated the necessity of prophylactic central lymph node dissection. Adopted chi square test and Logistic regression to analyze its relationship with patients′ gender, age, tumor number, tumor size, enveloped infiltration, single and bilateral tumor. All 277 patients underwent primary radical resection with ipsilateral central lymph node dissection. The specimen of resection was analyzed by routine pathology. Results The positive rate of thyroid papillary microcarcinoma lymph node metastasis was 36.8% （102/277）. The elements of male patients （P=0.023）, age 〈45 years （P〈0.001） and tumor diameter 〉0.5 cm （P=0.019） had high positive rate. The multivariable analysis showed that male patients （OR=2.63, P〈0.001）, age 〈45 years （OR=2.25, P=0.016）, tumor diameter 〉0.5 cm （OR=2.13, P=0.009） were independent risk factors for CLN metastasis.Forty-three （15.5%） cases had transient parathyroid function. No Permanent recurrent nerve paralysis and hyperparathyroidism occurred in this group. Conclusions Prophylactic central lymph node dissection is helpful for accurate staging of tumor classification and risk assessment, has important significance, on the followup of patients after treatment of choice. For male patients, age〈45, tumor diameter 〉0.5 cm, enveloped infiltration, the central compartment lymph node dissection may be necessary.