甲状腺微小癌位置与颈淋巴结转移的关系

The Correlation between the Location of Thyroid Papillary Microcarcinoma and Cervical Lymph Node Metastasis

目的探寻甲状腺乳头状微小癌病灶位置与颈淋巴结转移的关系.方法回顾分析云南省肿瘤医院头颈外科2013年1月至2016年1月收治334例甲状腺乳头状微小癌患者的临床资料,研究病灶位置、病灶大小、是否突破被膜等因素与颈部中央区淋巴结及颈侧区淋巴结转移的关系.结果甲状腺乳头状微小癌位于甲状腺上极时发生VI区淋巴结转移率为33.33%(26/104),中极为39.81%(43/108),下极为52.46%(64/122),肿瘤位于下极时更倾向于发生VI区淋巴结转移(P<0.05).发生颈侧区淋巴结转移者为46例(46/334,13.77%),上极肿瘤发生颈侧区淋巴结转移率为21.15%(22/104),中极为11.11%(12/108),下极为9.83%(12/122),病灶位于甲状腺上级时更倾向于发生颈侧区淋巴结转移(P=0.030),其中3例(6.5%)患者无中央区淋巴结转移而直接发生跳跃式颈侧区淋巴结转移。颈侧区淋巴结转移的患者中发生肿瘤突破被膜的比率为30.43%(14/46),高于未发生淋巴结转移的患者人群的19.09%(55/288)(P<0.05).结论甲状腺乳头状微小癌病灶位置与颈部淋巴结转移存在一定的相关性.

Objective To investigate the relationship between the location of thyroid papillary microcarcinoma and cervical lymph node metastasis. Me thods The clinical data of 334 cases of thyroid papillary microcarcinoma were retrospectively analyzed. The location of the lesion, the size of the lesion, the situation of the capsule and other factors were compared in patients with central lymph nodes or/and cervical lymph node metastasis.Re s ults The lymph node metastasis rate were 33.33%（26/104）,39.81%（43/108）,and 52.46%（64/122）,when the papillary thyroid microcarcinoma was located at the upper pole, median pole,and lower pole respectively（P〈0.005）. There were 46 cases（46/334, 13.77%） with cervical lymph node metastasis. The metastasis rate of cervical lymph node were 21.15%（22/104）, 11.11%（12/108）,and 9.83%（12/122）, when the papillary thyroid microcarcinoma was located at the upper pole, median pole,and lower pole respectively（P = 0.003）. 3 patients（6.5%） had no central lymph node metastasis and direct skipping of the cervical lymph nod trensfer. The rate of tumor break through through the membrane in patients with cervical lymph node metastases was 30.43%（14/46）, which was higher than the 19.09%（55/288） of patients without lymph node metastasis（P〈0.005）.Conclus ions There is a certain correlation between the location of papillary thyroid microcarcinoma and cervical lymph node metastasis.