中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2014年
3期
195-198
,共4页
俞甲子%王雅平%贝一冰%华鲁纯
俞甲子%王雅平%貝一冰%華魯純
유갑자%왕아평%패일빙%화로순
甲状腺肿瘤%癌,乳头状%淋巴转移%颈淋巴结清扫术
甲狀腺腫瘤%癌,乳頭狀%淋巴轉移%頸淋巴結清掃術
갑상선종류%암,유두상%림파전이%경림파결청소술
Thyroid neoplasms%Carcinoma,papillary%Lymphatic metastasis%Neck dissection
目的 研究术前临床检查颈部淋巴结阴性(cN0)甲状腺乳头状癌(PTC)患者发生Ⅵ区淋巴转移的危险因素及临床意义. 方法 回顾性分析2008年1月-2012年12月在复旦大学附属华山医院行甲状腺癌根治性切除+中央区淋巴结(CCLN)清扫术的272例cN0PTC患者临床资料.根据术后病理检查分为淋巴结转移组(115例)和淋巴结未转移组(157例),应用x2检验、秩和检验和多因素logistic回归模型对危险因素进行统计分析.结果 甲状腺乳头状微灶癌及非微灶乳头状癌CCLN转移率分别为34.9％、48.3％,单因素分析发现肿瘤直径(x2=10.26,P＜0.01)、单侧癌灶部位(x2=13.87,P＜0.01)、包膜侵犯(x2=20.19,P＜0.01)、单侧多灶性PTC(x2=7.42,P＜0.01)及非微灶癌(x2=5.12,P ＜0.05)与淋巴结转移显著相关;多因素logistic回归模型分析显示肿瘤位于甲状腺中部或下极、侵犯包膜、单侧多发癌灶为PTC患者CCLN转移的独立危险因素.结论 cN0 PTC有较高的CCLN转移率,对PTC患者清扫中央区的淋巴结是十分必要的.
目的 研究術前臨床檢查頸部淋巴結陰性(cN0)甲狀腺乳頭狀癌(PTC)患者髮生Ⅵ區淋巴轉移的危險因素及臨床意義. 方法 迴顧性分析2008年1月-2012年12月在複旦大學附屬華山醫院行甲狀腺癌根治性切除+中央區淋巴結(CCLN)清掃術的272例cN0PTC患者臨床資料.根據術後病理檢查分為淋巴結轉移組(115例)和淋巴結未轉移組(157例),應用x2檢驗、秩和檢驗和多因素logistic迴歸模型對危險因素進行統計分析.結果 甲狀腺乳頭狀微竈癌及非微竈乳頭狀癌CCLN轉移率分彆為34.9％、48.3％,單因素分析髮現腫瘤直徑(x2=10.26,P＜0.01)、單側癌竈部位(x2=13.87,P＜0.01)、包膜侵犯(x2=20.19,P＜0.01)、單側多竈性PTC(x2=7.42,P＜0.01)及非微竈癌(x2=5.12,P ＜0.05)與淋巴結轉移顯著相關;多因素logistic迴歸模型分析顯示腫瘤位于甲狀腺中部或下極、侵犯包膜、單側多髮癌竈為PTC患者CCLN轉移的獨立危險因素.結論 cN0 PTC有較高的CCLN轉移率,對PTC患者清掃中央區的淋巴結是十分必要的.
목적 연구술전림상검사경부림파결음성(cN0)갑상선유두상암(PTC)환자발생Ⅵ구림파전이적위험인소급림상의의. 방법 회고성분석2008년1월-2012년12월재복단대학부속화산의원행갑상선암근치성절제+중앙구림파결(CCLN)청소술적272례cN0PTC환자림상자료.근거술후병리검사분위림파결전이조(115례)화림파결미전이조(157례),응용x2검험、질화검험화다인소logistic회귀모형대위험인소진행통계분석.결과 갑상선유두상미조암급비미조유두상암CCLN전이솔분별위34.9％、48.3％,단인소분석발현종류직경(x2=10.26,P＜0.01)、단측암조부위(x2=13.87,P＜0.01)、포막침범(x2=20.19,P＜0.01)、단측다조성PTC(x2=7.42,P＜0.01)급비미조암(x2=5.12,P ＜0.05)여림파결전이현저상관;다인소logistic회귀모형분석현시종류위우갑상선중부혹하겁、침범포막、단측다발암조위PTC환자CCLN전이적독립위험인소.결론 cN0 PTC유교고적CCLN전이솔,대PTC환자청소중앙구적림파결시십분필요적.
Objective To analyze the risk factors of central compartment lymph node (CCLN)metastasis in papillary thyroid carcinoma(PTC) without clinically suspected cervical lymph node metastasis (cN0).Methods Clinical data of 272 PTC (cN0) patients who underwent radical thyroidectomy and CCLN dissection between January 2008 and December 2012 in Huashan hospital were retrospectively analyzed.Patients were divided into CCLN positive group (115 cases)and CCLN negative group(157 cases) according to postoperative pathology.Chi-square test,wilcoxon test and multivariate logistic regression analysis were used to analyze risk factors.Results CCLN metastasis of papillary micro thyroid cancer (PMTC) and papillary thyroid cancer (PTC) was 34.9％ and 48.3％,respectively.Tumor size (x2 =10.26,P ＜ 0.01),position(x2 =13.87,P ＜ 0.01),capsular invasion(x2 =20.19,P ＜ 0.01),multifocal PTC(x2 =7.42,P ＜ 0.01) and unmicro-carcinoma (x2 =5.12,P ＜ 0.05) were significantly correlated to lymph node metastasis.Middle area or lower pole of thyroid carcinoma,capsular invasion and multifocal PTC were independent risk factors of CCLN metastasis in PTC.Conclusions The cN0 PTC has a high rate of pathological CCLN metastasis,it is imperative to conduct thyroidectomy with ipsilateral level CCLN dissection in PTC patients.
