甲状腺微小乳头状癌行中央区淋巴结清扫的必要性探究

徐新江; 蒋斌; 韩靓

doi:10.13201/j.issn.1001-1781.2014.06.002

甲状腺微小乳头状癌行中央区淋巴结清扫的必要性探究

- 南通大学附属肿瘤医院头颈外科(江苏南通, 226361)

详细信息

通讯作者: 徐新江, E-mail:xxj1025wp@qq.com

中图分类号: R736.1

收稿日期: 2013-06-04

Necessity of central lymph node dissection in management of papillary thyroid microcarcinoma

- Department of Head and Neck Surgery, the Tumor Hospital Affiliated to Nantong University, Nantong, 226361, China

More Information

Corresponding author: XU Xinjiang, E-mail: xxj1025wp@qq.com

Received Date: 04 June 2013

摘要

摘要: 目的:分析甲状腺微小乳头状癌发生中央区淋巴结转移的危险因素,探讨中央区淋巴结清扫的必要性。方法:回顾2004-01-2012-05期间手术治疗的85例甲状腺微小乳头状癌患者的临床资料,通过单因素及多因素分析,明确中央区淋巴结转移的危险因素,为选择性地进行中央区淋巴结清扫术提供依据。结果:85例患者均接受了中央区淋巴结清扫术,其中同侧中央区清扫者66例,双侧中央区清扫者19例。3例同期行颈部淋巴结清扫术。33例(38.8%)发生中央区淋巴结转移,3例(3.53%)发生颈侧区淋巴结转移。单因素分析显示:不同性别、年龄组中央区淋巴结转移差异无统计学意义(P>0.05);肿瘤直径大于5 mm、甲状腺外侵犯、多中心病灶、双侧病灶及术中探及中央区可疑阳性巴结者,发生中央区淋巴结转移的比例明显增高(P<0.05)。多因素分析显示:肿瘤直径大于5 mm(OR=3.862,P<0.05)、甲状腺外侵犯(OR=3.885,P<0.05)是发生中央区淋巴结转移的独立危险因素。结论:甲状腺微小乳头状癌患者肿瘤直径大5 mm和(或)甲状腺外侵犯时,发生中央区淋巴结转移的危险性增加,有必要行中央区淋巴结清扫术。
- 甲状腺微小乳头状癌 /
- 中央区淋巴结清扫 /
- 危险因素
Abstract: Objective:The objective of this study was to identify the risk factors for central lymph node metastasis(CLNM) of papillary thyroid microcarcinoma(PTMC) and to explore the necessity of central lymph node dissection(CLND).Method:Clinical data of 85 patients with PTMC, who had undergone surgical treatment between January 2004 and May 2012, were retrospected.Risk factors for CLNM were identified by univariate analysis and multivariate analysis,which can provide the basis for elective performance of CLND.Result:Of 85 patients,66 patients underwent ipsilateral CLND,while 19 patients received bilateral CLND.Concurrent cervical lymph node dissection was performed in 3 patients.The incidence of central and cervical lymph node metastasis was 38.8% and 3.53%,respectively. Univariate analysis showed that CLNM was correlated with tumor size >5 mm,extrathyroidal extension, multifocality, bilaterality and intraoperatively suspected lymph node,but not related to gender and age. Upon multivariate analysis, tumor size >5 mm(OR=3.862,P<0.05) and extrathyroidal extension(OR=3.885,P<0.05) were independent risk factors for CLNM.Conclusion:Patients presenting tumor size >5 mm and/or extrathyroidal extension may have an increased risk of central lymph node metastasis,and it is necessary to perform central lymph node dissection for them.
- papillary thyroid microcarcinoma /
- central lymph node dissection /
- risk factor

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