CAJ | 학술논문

目的探讨cN0单发甲状腺乳头状癌中央区淋巴结转移的规律,为中央区清扫的最佳范围提供依据.方法对150例cN0单发甲状腺乳头状癌患者行甲状腺全切除+双侧中央区淋巴结清扫术,以甲状软骨下角下方1 cm的水平线将双侧中央区分为患侧甲状软骨下角区域、患侧中央区下份、对侧甲状软骨下角区域、对侧中央区下份4个区域,分析这4个区域淋巴结转移的差异及影响因素.结果患侧中央区下份淋巴结转移率在4个区域中最高(56.7％),其次是对侧中央区下份(28.0％),再次是患侧甲状软骨下角区域(17.3％),对侧甲状软骨下角区域淋巴结均无转移(0).在多因素分析中,侵及甲状腺被膜是患侧甲状软骨下角区域(β =0.1835,x2=0.3102)和对侧中央区下份(β =0.3166,x2=1.4640)淋巴结转移的独立影响因素(P＜0.05);年龄≥45岁(β=0.5737,x2=6.5923)、侵及甲状腺被膜(β=0.4258,x2=3.4735)是患侧中央区下份淋巴结转移的独立影响因素(P＜0.05).结论 cN0单发甲状腺乳头状癌对侧甲状软骨下角区域淋巴结可以不行常规清扫.
목적 탐토cN0단발갑상선유두상암중앙구림파결전이적규률,위중앙구청소적최가범위제공의거.방법 대150례cN0단발갑상선유두상암환자행갑상선전절제+쌍측중앙구림파결청소술,이갑상연골하각하방1 cm적수평선장쌍측중앙구분위환측갑상연골하각구역、환측중앙구하빈、대측갑상연골하각구역、대측중앙구하빈4개구역,분석저4개구역림파결전이적차이급영향인소.결과 환측중앙구하빈림파결전이솔재4개구역중최고(56.7％),기차시대측중앙구하빈(28.0％),재차시환측갑상연골하각구역(17.3％),대측갑상연골하각구역림파결균무전이(0).재다인소분석중,침급갑상선피막시환측갑상연골하각구역(β =0.1835,x2=0.3102)화대측중앙구하빈(β =0.3166,x2=1.4640)림파결전이적독립영향인소(P＜0.05);년령≥45세(β=0.5737,x2=6.5923)、침급갑상선피막(β=0.4258,x2=3.4735)시환측중앙구하빈림파결전이적독립영향인소(P＜0.05).결론 cN0단발갑상선유두상암대측갑상연골하각구역림파결가이불행상규청소.
Objective To discuss the pattern of central lymph node metastasis of cN0 single thyroid papillary carcinoma and provide clinical evidence-supported proof for central lymph node dissection.Methods The performed thyroidectomy and bilateral central lymph node dissection for 150 patients with cN0 single papillary thyroid carcinoma.The bilateral central lymph nodes were divided into 4 parts:the comu inferius cartilaginis thyroideae region of ipsilateral central area,the lower part of ipsilateral central area,the cornu inferius cartilaginis thyroideae region of contralateral central area,the lower part of contralateral central area on the baseline of 1 cm below the cornu inferius cartilaginis thyroideae.We analyzed the differences and influencing factors of lymph node metastasis in these 4 parts.Results The lymph node metastasis rate in lower part of ipsilateral central area was the highest (56.7％),followed by the lower part of contralateral central area (28.0％),the cornu inferius cartilaginis thyroideae region of ipsilateral central area (17.3％),and the cornu inferius cartilaginis thyroideae region of contralateral central area (0).In the logistic analysis of multiple factors,invaded thyroid capsule was an independent factor for lymph node metastasis in both the cornu inferius cartilaginis thyroideae region of ipsilateral central area (β =0.1835,x2 =0.3102,P ＜0.05) and lower part of contralateral area (β =0.3166,x2 =1.4640,P ＜ 0.05).The patients' age ≥ 45 years (β =0.5737,x2 =6.5923) and invaded thyroid capsule (β =0.4258,x2 =3.4735) were independent factors for lower part of ipsilateral central area (both P ＜ 0.05).Conclusion The cornu inferius cartilaginis thyroideae region of contralateral central area of cN0 single PTC patients could not be cleared routinely.