甲状腺乳头状癌颈内静脉后群淋巴结转移的临床研究

Clinical study of lymph node metastasis of posterior jugular vein group in papillary thyroid carcinoma

目的:探讨影响甲状腺乳头状癌(PTC)颈内静脉后群淋巴结转移的的危险因素,为临床制定合理的手术方案提供理论依据。方法:回顾性分析2018年6月至2021年12月行根治性切除术及颈内静脉后群淋巴结清扫术的225例PTC患者病例资料,根据颈内静脉后群淋巴结转移情况分为非转移组(n=135例)和转移组(n=90例)。采用Logistic回归模型对单因素分析结果中差异有统计学意义的相关危险因素进行多因素分析。应用软件SPSS 22.0对数据进行统计学分析,当P<0.05时认为差异具有统计学意义。结果:225例PTC患者颈内静脉后群淋巴结清扫总数为2719枚,阳性淋巴结数为195枚,淋巴结转移比为7.2%;单因素分析结果显示,PTC患者颈内静脉后群淋巴结转移与年龄、BMI、肿瘤直径、肿瘤位置、肿瘤数目、中央区淋巴结转移及颈内静脉肩胛舌骨肌淋巴结转移呈明显相关性(P<0.05);Logistic回归分析显示,肿瘤直径>1 cm、肿瘤位置中上部、肿瘤数目多灶(≥2个)、中央区淋巴结转移及颈内静脉肩胛舌骨肌淋巴结转移是PTC患者颈内静脉后群淋巴结转移的独立危险因素(P<0.05)。结论:肿瘤直径、肿瘤位置、肿瘤数目、中央区淋巴结转移及颈内静脉肩胛舌骨肌淋巴结转移为PTC患者颈内静脉后群淋巴结转移的独立危险因素,在临床治疗时建议对存在这些危险因素的PTC患者行颈内静脉后群淋巴结清扫术。

Objective To explore the risk factors affecting lymph node metastasis of posterior jugular vein group in papillary thyroid carcinoma,and to provide theoretical basis for clinical development of reasonable surgical protocols.Methods Pathological data of 225 patients with PTC who underwent radical resection and lymph node dissection in posterior jugular vein group from June 2018 to December 2021 were retrospectively analyzed.According to lymph node metastasis in posterior jugular vein group,they were divided into non-metastatic group(n=135 cases)and metastatic group(n=90 cases).Logistic regression model was used to analyze the risk factors with statistically significant differences in the univariate analysis results.SPSS 22.O was used for statistical analysis of the data,and the dfference was considered statistically significant when P<0.05.Results A total of 2719 lymph nodes were dissected in the posterior jugular vein group of 225 PTC patients,with 195 positive lymph nodes,and the lymph node metastasis ratio was 7.2%.Univariate analysis showed that lymph node metastasis of posterior jugular vein group in PTC patients was significantly correlated with age,BMI,tumor diameter,tumor location,tumor number,central lymph node metastasis and lymph node metastasis of internal jugular vein omohyoid muscle(P<0.05).Logistic regression analysis showed that tumor diameter>1 cm,tumor location in the middle and upper part,multiple tumors(≥2),central lymph node metastasis and internal jugular vein omohyoid lymph node metastasis were independent risk factors for lymph node metastasis in patients with PTC(P<0.05).Conclusion Tumor diameter,tumor location,tumor number,central lymph node metastasis and internal jugular vein omohyoid lymph node metastasis are independent risk factors for postjugular lymph node metastasis in PTC patients,and it is recommended to perform postjugular lymph nodedissection for PTC patients with these risk factors in clinical treatment.