中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
7期
625-628
,共4页
陈锐%魏涛%李志辉%龚日祥%朱精强
陳銳%魏濤%李誌輝%龔日祥%硃精彊
진예%위도%리지휘%공일상%주정강
甲状腺肿瘤%癌,乳头状%淋巴转移%颈淋巴结清扫术%危险因素
甲狀腺腫瘤%癌,乳頭狀%淋巴轉移%頸淋巴結清掃術%危險因素
갑상선종류%암,유두상%림파전이%경림파결청소술%위험인소
Thyroid neoplasms%Carcinoma,papillary%Lymphatic metastasis%Neck dissection%Risk factors
目的 探讨甲状腺乳头状癌颈部Ⅴ区淋巴结转移的预测因素,为确定甲状腺乳头状癌患者清扫Ⅴ区淋巴结的指征寻找依据.方法 回顾性分析2004年3月至2010年11月资料完整的122例甲状腺乳头状癌患者的临床病理资料.其中男性31例,女性91例；年龄8～87岁,中位年龄38.5岁.每个病例至少行一侧Ⅱ～Ⅵ区颈淋巴结清扫术,13例行Ⅰ～Ⅵ区颈淋巴结清扫术,19例行双侧颈淋巴结清扫术.用x2检验对患者年龄、性别、术前远处转移、术后TNM分期、原发灶大小、癌灶多发、肿瘤浸润情况、中央区及同侧Ⅱ～Ⅳ区淋巴结转移情况与Ⅴ区淋巴结转移进行单因素分析,用二分类Logistic回归对单因素分析中有统计学意义的指标进行多因素分析.结果 甲状腺乳头状癌患者Ⅴ区淋巴结转移组与未转移组在年龄、性别、癌灶多发、中央区淋巴结转移、同侧Ⅱ区淋巴结转移、同侧Ⅲ区淋巴结转移及术后TNM分期等因素比较中差异无统计学意义(x2=0.882～3.167,P＞0.05),而在肿瘤浸润被膜、浸润甲状腺外组织、术前远处转移、原发灶＞4.0cm、同侧Ⅳ区淋巴结转移及同侧Ⅱ、Ⅲ、Ⅳ区淋巴结同时转移等因素中差异有统计学意义(x2 =4.223～ 13.748,P＜0.05).多因素分析显示,肿瘤浸润甲状腺外组织(OR =8.32,95％ CI:2.44 ～28.3,P=0.001)和同侧Ⅱ、Ⅲ、Ⅳ 区淋巴结同时转移(OR=7.81,95％CI:2.11 ～28.8,P=0.002)是Ⅴ区淋巴结转移的高危因素.结论 肿瘤浸润甲状腺外组织及同侧Ⅱ、Ⅲ、Ⅳ区淋巴结同时转移是甲状腺乳头状癌患者Ⅴ区淋巴结转移的危险因素,对于这一类患者建议行Ⅴ区淋巴结清扫.
目的 探討甲狀腺乳頭狀癌頸部Ⅴ區淋巴結轉移的預測因素,為確定甲狀腺乳頭狀癌患者清掃Ⅴ區淋巴結的指徵尋找依據.方法 迴顧性分析2004年3月至2010年11月資料完整的122例甲狀腺乳頭狀癌患者的臨床病理資料.其中男性31例,女性91例；年齡8～87歲,中位年齡38.5歲.每箇病例至少行一側Ⅱ～Ⅵ區頸淋巴結清掃術,13例行Ⅰ～Ⅵ區頸淋巴結清掃術,19例行雙側頸淋巴結清掃術.用x2檢驗對患者年齡、性彆、術前遠處轉移、術後TNM分期、原髮竈大小、癌竈多髮、腫瘤浸潤情況、中央區及同側Ⅱ～Ⅳ區淋巴結轉移情況與Ⅴ區淋巴結轉移進行單因素分析,用二分類Logistic迴歸對單因素分析中有統計學意義的指標進行多因素分析.結果 甲狀腺乳頭狀癌患者Ⅴ區淋巴結轉移組與未轉移組在年齡、性彆、癌竈多髮、中央區淋巴結轉移、同側Ⅱ區淋巴結轉移、同側Ⅲ區淋巴結轉移及術後TNM分期等因素比較中差異無統計學意義(x2=0.882～3.167,P＞0.05),而在腫瘤浸潤被膜、浸潤甲狀腺外組織、術前遠處轉移、原髮竈＞4.0cm、同側Ⅳ區淋巴結轉移及同側Ⅱ、Ⅲ、Ⅳ區淋巴結同時轉移等因素中差異有統計學意義(x2 =4.223～ 13.748,P＜0.05).多因素分析顯示,腫瘤浸潤甲狀腺外組織(OR =8.32,95％ CI:2.44 ～28.3,P=0.001)和同側Ⅱ、Ⅲ、Ⅳ 區淋巴結同時轉移(OR=7.81,95％CI:2.11 ～28.8,P=0.002)是Ⅴ區淋巴結轉移的高危因素.結論 腫瘤浸潤甲狀腺外組織及同側Ⅱ、Ⅲ、Ⅳ區淋巴結同時轉移是甲狀腺乳頭狀癌患者Ⅴ區淋巴結轉移的危險因素,對于這一類患者建議行Ⅴ區淋巴結清掃.
목적 탐토갑상선유두상암경부Ⅴ구림파결전이적예측인소,위학정갑상선유두상암환자청소Ⅴ구림파결적지정심조의거.방법 회고성분석2004년3월지2010년11월자료완정적122례갑상선유두상암환자적림상병리자료.기중남성31례,녀성91례；년령8～87세,중위년령38.5세.매개병례지소행일측Ⅱ～Ⅵ구경림파결청소술,13례행Ⅰ～Ⅵ구경림파결청소술,19례행쌍측경림파결청소술.용x2검험대환자년령、성별、술전원처전이、술후TNM분기、원발조대소、암조다발、종류침윤정황、중앙구급동측Ⅱ～Ⅳ구림파결전이정황여Ⅴ구림파결전이진행단인소분석,용이분류Logistic회귀대단인소분석중유통계학의의적지표진행다인소분석.결과 갑상선유두상암환자Ⅴ구림파결전이조여미전이조재년령、성별、암조다발、중앙구림파결전이、동측Ⅱ구림파결전이、동측Ⅲ구림파결전이급술후TNM분기등인소비교중차이무통계학의의(x2=0.882～3.167,P＞0.05),이재종류침윤피막、침윤갑상선외조직、술전원처전이、원발조＞4.0cm、동측Ⅳ구림파결전이급동측Ⅱ、Ⅲ、Ⅳ구림파결동시전이등인소중차이유통계학의의(x2 =4.223～ 13.748,P＜0.05).다인소분석현시,종류침윤갑상선외조직(OR =8.32,95％ CI:2.44 ～28.3,P=0.001)화동측Ⅱ、Ⅲ、Ⅳ 구림파결동시전이(OR=7.81,95％CI:2.11 ～28.8,P=0.002)시Ⅴ구림파결전이적고위인소.결론 종류침윤갑상선외조직급동측Ⅱ、Ⅲ、Ⅳ구림파결동시전이시갑상선유두상암환자Ⅴ구림파결전이적위험인소,대우저일류환자건의행Ⅴ구림파결청소.
Objective To study the predictors of level Ⅴ metastasis in papillary thyroid carcinoma (PTC).Methods The clinic data of 122 patients with PTC who underwent therapeutic lateral neck dissection between March 2004 and November 2010 was analyzed retrospectively.There were 31 male and 91 female patients.The median age at diagnosis was 38.5 years ( ranging from 8 to 87 years).All the patients had undergone unilateral or bilateral lymph node dissection ( Ⅱ-Ⅵ or Ⅰ-Ⅵ ).Univariate analysis and multivariate analysis were performed using x2 test and binary Logistic regression test,respectively.Result The level Ⅴ metastases was significantly associated with capsular invasion,extrathyroidal extension,preoperative distant metastasis,the size of primary,ipsilateral level Ⅳ lymph node metastasis and simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ ( x2 =4.223-13.748,P ＜ 0.05 ).Age,sex,tumor-multifocal,pTNM,central lymph node metastases ipsilateral level Ⅱ lymph node metastases and ipsilateral level Ⅲ lymph node metastases were not found to be associated with level Ⅴ metastases (x2 =0.882-3.167,P ＞0.05 ).In multivariate analysis,extrathyroidal extension ( OR =8.32,95％ CI:2.44-28.3,P=0.001 ) and simultaneous me tastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ (OR =7.81,95％ CI:2.11-28.8,P =0.002 ) were independent predictors of level Ⅴ metastasis.Conclusions Extrathyroidal extension,simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ are risk factors for level Ⅴ lymph nodes metastases in PTC.Dissection of level Ⅴ lymph nodes should be considered for PTC patients with extrathvroidal extension and simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ.
