甲状腺乳头状癌预防性中央区淋巴结清扫获得淋巴结数目的影响因素

Factors influencing number of lymph nodes obtained by prophylactic central lymph node dissection for pap⁃illary thyroid cancer

目的探讨影响甲状腺乳头状癌行单侧腺叶及峡部切除联合预防性同侧中央区淋巴结清扫术获得淋巴结数目的因素,分析变化规律,以期为临床治疗甲状腺乳头状癌提供重要依据。方法回顾性分析锦州医科大学附属第一医院甲状腺外科于2019年1月至2022年1月因甲状腺乳头状癌收治入院并行单侧腺叶及峡部切除联合预防性同侧中央区淋巴结清扫术的患者193例的临床和病理资料,将病理所获得淋巴结数目分为高获得淋巴结数目组(n>6枚)和低获得淋巴结数目组(n≤6枚),采用单因素分析和多因素分析的方法找出影响高获得淋巴结数目的影响因素,通过相关分析判断获得淋巴结数目对中央区淋巴结转移的影响,此外,通过术后并发症分析获得淋巴结数目对患者生存质量的影响。结果获得淋巴结数目与中央区淋巴结转移数目(r=0.240,P<0.05)和淋巴结转移率(r=0.161,P<0.05)分别呈线性正相关,控制转移淋巴结数目不变,淋巴结转移率随获得淋巴结数的上升而降低(r=-0.444,P<0.05)。两组获得淋巴结数目单因素分析比较,性别、年龄、手术时长、BMI、肿瘤最大直径、多灶性、桥本甲状腺炎、病灶位置、被膜侵犯、对侧甲状腺结节、甲状旁腺移植、BRAF基因V600E突变差异无统计学意义(P>0.05),应用纳米碳在两组比较中差异有统计学意义(P<0.05),logistic二元回归分析结果显示合并桥本氏甲状腺炎和应用纳米碳是高获得淋巴结数目的独立影响因素(P<0.05)。ROC曲线分析提示应用纳米碳所占曲线下面积为0.658(95%CI:0.580~0.735,P<0.05),桥本甲状腺炎所占曲线下面积为0.584(95%CI:0.504~0.665,P<0.05)。此外,术后患者声带麻痹和淋巴漏的发生在高、低获得淋巴结数目组之间差异无统计学意义(P>0.05)。结论控制中央区淋巴结转移数目不变,获得淋巴结数目越多,淋巴结转移率越低,应用纳米碳及患者合并桥本甲状腺炎可提高获得淋巴结数目,高、低获得淋巴结数目在术后并发症的发生率方面无明显差别。

Objective To investigate the factors affecting the number of lymph nodes obtained by unilateral lobectomy and isthmus combined with prophylactic ipsilateral central lymph node dissection for papillary thyroid cancer,and to analyze the pattern of change so as to provide an important basis for clinical treatment of papillary thyroid cancer.Methods Retrospective analysis was performed on the clinical and pathological data of 193 patients admitted to the department of Thyroid Surgery of the First Affiliated Hospital of Jinzhou Medical University from January 2019 to January 2022 for papillary thyroid cancer who underwent unilateral glandular lobe and isthmus resec⁃tion combined with prophylactic ipsilateral central lymph node dissection.The number of obtained lymph nodes was divided into a group with high number of obtained lymph nodes(n>6)and a group with low number of obtained lymph nodes(n≤6).Univariate analysis and multivariate analysis were used to explore the factors affecting the num⁃ber of obtained lymph nodes.The influence of the number of lymph nodes on the central lymph node metastasis was evaluated by correlation analysis,and the influence of the number of lymph nodes on the quality of life of patients by postoperative complications analysis.Results The number of lymph nodes obtained was positively correlated with the number of lymph node metastases in the central region(r=0.240,P<0.05)and the rate of lymph node metastasis(r=0.161,P<0.05),respectively.The number of lymph node metastases controlled remained unchanged,and the rate of lymph node metastasis decreased with the increase of the number of obtained lymph nodes(r=-0.444,P<0.05).Univariate analysis of the number of lymph nodes between the two groups showed no significant differences in terms of sex,age,operation duration,BMI,maximum tumor diameter,multifocality,Hashimoto's thyroiditis,focal location,capsular invasion,contralateral thyroid nodule,parathyroid transplantation and BRAF gene V600E mutation(P>0.05).There was statistical significance in the application of nano carbon between the two groups(P<0.05).Logistic binary regression analysis showed that the combination of Hashimoto's thyroiditis and the application of carbon nanoparticles were independent influencing factors for the high number of lymph nodes obtained(P<0.05).ROC curve analysis suggested that the area under the curve occupied by carbon nanoscale was 0.658(95%CI:0.580~0.735,P<0.05),and the area under the curve occupied by Hashimoto's thyroiditis was 0.584(95%CI:0.504~0.665,P<0.05).In addition,there was no significant difference in the incidence of vocal cord paralysis and lymphatic leakage between the two groups(P>0.05).Conclusions When the number of lymph nodes in the cen⁃tral region remained unchanged,the higher the number of lymph nodes obtained,the lower the rate of lymph node metastasis.The application of nano⁃carbon and patients with Hashimoto's thyroiditis could increase the number of lymph nodes obtained,and there is no significant difference in the incidence of postoperative complications between high and low number of lymph nodes obtained.