甲状腺乳头状癌病人甲状腺全切术右侧喉返神经深层淋巴结转移情况分析

Analysis of deep lymph node metastasis of right recurrent laryngeal nerve in patients with papillary thyroid carcinoma undergoing total thyroidectomy

目的分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)病人全切术右侧喉返神经深层淋巴结转移情况及相关影响因素.方法2017年11月~2019年11月间收治的PTC病人80例,所有病人根据病情进行全切术联合双侧中央区淋巴结清扫或右侧中央区域淋巴结清扫,根据喉返神经作为界限将右侧中央区域淋巴结分为浅层区(Ⅵa)与深层区(Ⅵb),对所有清扫的淋巴结病理标本进行及时检测,并根据检测结果确定记录所有病人的淋巴结转移情况,对相关因素进行单因素及多因素Logistic回归分析.结果80例PTC病人中共有47例病人出现颈部淋巴结转移,淋巴结转移阳性率为58.8%,平均清扫淋巴结数为(13.65±2.15)个,平均淋巴结阳性数为(5.61±1.17)个.其中右侧喉返神经深层淋巴结阳性12例,阳性率为15.0%,浅层淋巴结阳性率为55.0%,右侧喉返神经深层淋巴结阳性合并浅层淋巴结阳性率为12.5%,颈侧区淋巴结阳性率为6.3%.单因素及多因素Logistic回归分析发现,肿瘤多发、肿瘤直径≥10 mm、右侧喉返神经浅层淋巴结阳性及颈侧区淋巴结阳性是影响PTC病人右侧喉返神经深层淋巴结转移的独立危险因素.结论肿瘤数量、肿瘤大小、右侧喉返神经浅层淋巴结阳性及颈侧区淋巴结是影响PTC病人右侧喉返神经深层淋巴结转移的危险因素,对于这部分病人中央区淋巴结清扫范围应包括右侧喉返神经深层淋巴结,才能最大程度保证淋巴结清扫的彻底性,减少术后复发的风险.

Objective To investigate the deep lymph node metastasis of right recurrent laryngeal nerve(RLN)in patients with papillary thyroid carcinoma(PTC)after total thyroidectomy.Methods 80 patients with papillary thyroid cancer in our hospital from November 2017 to November 2019 were selected.All patients were treated with total thyroidectomy combined with bilateral central lymph node dissection or right central lymph node dissection according to their condition.The right central lymph nodes were divided into superficial(Ⅵa)and deep(Ⅵb)according to the boundary of recurrent laryngeal nerve,The pathological samples of all lymph nodes were detected in time,and the lymph node metastasis of all patients was recorded according to the detection results.The related factors were analyzed by univariate and multivariate logistic regression analysis.Results In this study,47 cases of PTC patients had cervical lymph node metastasis,the positive rate of lymph node metastasis was 58.8%,the average number of lymph node dissection was 13.65±2.15,the average number of positive lymph nodes was 5.61±1.17.Among them,the positive rate of deep lymph nodes of right recurrent laryngeal nerve was 15.0%,the positive rate of superficial lymph nodes was 55.0%,the positive rate of deep lymph nodes of right recurrent laryngeal nerve combined with superficial lymph nodes was 12.5%,and the positive rate of cervical lymph nodes was 6.3%.After univariate and multivariate logistic regression analysis,multiple tumors,tumor diameter>10mm,positive lymph nodes in superficial layer of right recurrent laryngeal nerve and positive lymph nodes in lateral cervical region were independent risk factors of deep lymph node metastasis of right recurrent laryngeal nerve in PTC patients,and the difference was statistically significant(P<0.05).Conclusion The number of tumors,tumor size,the positive superficial lymph nodes of the right recurrent laryngeal nerve and the cervical lymph nodes are the risk factors affecting the deep lymph node metastasis of the right recurrent laryngeal nerve in PTC patients.For these patients,the range of central lymph node dissection should include the deep lymph node of the right recurrent laryngeal nerve,in order to ensure the thoroughness of lymph node dissection and reduce the risk of postoperative recurrence.