83例cN0期甲状腺乳头状癌患者行中央区淋巴结清扫的临床数据分析

Analysis of Clinical Data of 83 Patients with cN0 Thyroid Papillary Carcinoma Undergoing Central Lymph Node Dissection

目的分析cN0期甲状腺乳头状癌中央区淋巴结转移的相关危险因素,探讨甲状腺乳头状癌手术同期行中央区淋巴结清扫的意义。方法回顾性分析2014年8月—2018年11月间首次手术治疗的83例甲状腺乳头状癌患者的临床病理资料,常规预防性行同侧中央区淋巴结清扫术,观察术后并发症情况以及随访预后,分析患者的临床病理资料与中央区淋巴结转移的相关性。结果83例患者中26例有中央区淋巴结转移(63.9%),转移率与性别(χ^2=0.053,P=0.818)、肿瘤是否多病灶(χ^2=0.922,P=0.337)无明显相关。而年龄<45岁者的中央区淋巴结转移率明显高于年龄≥45岁者(48.6%vs 18.8%,χ^2=8.368,P=0.004),肿瘤直径>1 cm者的中央区淋巴结转移率显著高于肿瘤直径≤1 cm者(48.0%vs 24.1%,χ^2=5.234,P=0.022),肿瘤侵犯甲状腺被膜者的中央区淋巴结转移率显著高于无被膜侵犯者(48.3%vs 22.2%,χ^2=5.593,P=0.015),均差异有统计学意义(P<0.05)。83例患者中2例发生甲状旁腺永久性损伤,1例发生喉返神经损伤。结论PTC患者有一定的颈部淋巴结转移风险,应在手术技术保障的前提下对PTC患者常规行中央区淋巴结清扫术。

Objective To analyze the risk factors of central lymph node metastasis in cN0 stage thyroid papillary carcinoma,and to explore the significance of central lymph node dissection in thyroid papillary carcinoma surgery.Methods The clinical and pathological data of 83 patients with thyroid papillary carcinoma who underwent primary surgery from August 2014 to November 2018 were retrospectively analyzed.The routine preventive ipsilateral central lymph node dissection was performed to observe postoperative complications and follow-up prognosis,analysis of the correlation between clinical pathological data and central lymph node metastasis.Results Among the 83 patients,26 had central lymph node metastasis(63.9%).The metastatic rate was not significantly correlated with gender(χ^2=0.053,P=0.818)and whether the tumor had multiple lesions(χ^2=0.922,P=0.337).The central lymph node metastasis rate was significantly higher in those aged<45 years(48.6%vs 18.8%,χ^2=8.368,P=0.004),and the central lymph node metastasis rate was significantly higher in patients with tumor diameter>1 cm,higher than patients with tumor diameter≤1 cm(48.0%vs 24.1%,χ^2=5.234,P=0.022),the central lymph node metastasis rate of tumor invasion of thyroid capsule was significantly higher than that of non-membrane invasion(48.3%vs 22.2%,χ^2=5.593,P=0.015),both were statistically significant(P<0.05).Of the 83 patients,2 had permanent parathyroid injury and 1 had recurrent laryngeal nerve injury.Conclusion PTC patients have a certain risk of cervical lymph node metastasis.Central plexus lymph node dissection should be performed on PTC patients under the premise of surgical technique.