摘要
目的 探讨分化型甲状腺癌患者颈静脉角淋巴结转移的危险因素、处理方法及意义.方法 收集2012年12月至2014年1月收治的222例分化型甲状腺癌患者的临床资料,对手术方法、并发症、术后淋巴结病理结果进行分析.结果 发生淋巴结转移133例.Ⅵ区淋巴结阳性时侧颈区淋巴结阳性率：Ⅱ区43%（57/133）、Ⅲ区54%（72/133）、Ⅳ区45%（60/133）、颈静脉角处60%（80/133）、Ⅴ区6%（8/133）.功能性淋巴结清扫术（FND）组术中出血量、手术时间、住院时间均显著高于择区性颈部淋巴结清扫术（SDN）组中的切除颈前肌群组和保留颈前肌群组,差异有统计学意义（P〈0.05）.单因素分析结果表明,肿瘤最大直径、甲状腺被膜侵犯、中央区淋巴结转移情况与颈静脉角处淋巴结转移相关（P〈0.01）.Logistic回归分析结果表明,甲状腺被膜侵犯（OR=3.539）,中央区淋巴结转移情况（OR=1.617）,肿瘤最大直径（OR=1.321）是颈静脉角淋巴结转移的影响因素.结论 肿瘤直径≥1.5 cm、甲状腺被膜侵犯、中央区淋巴结转移数≥2个的分化型甲状腺癌患者,应行侧颈淋巴结清扫,还要注意颈静脉角处的淋巴结清扫,这样才能做到根治度大于转移度.
Objective To investigate the risk factors, treatment methods and significance of the cervical venous angle lymph node metastasis in differentiated thyroid cancer. Methods The clinical data of 222 patients with thyroid papillary carcinoma from December 2012 to January 2014 were collected. The surgical methods, complications and postoperative complications and pathology were analyzed. Results Lymph node metastasis was found in 133 cases. when VI lymph node was positive , the lateral cervical lymph node positive rate was 43%（57/133） inⅡDistrict, 54%（72/133） inⅢDistrict,ⅣDistrict 45%（60/133） inⅣDistrict, 60%（80/133） in jugular angle, and 6%（8/133） in V District. The levels of bleeding volume, operation time and hospitalization time in functional neck dissection （FND） group were significantly higher than those in anterior cervical muscle group and reserved anterior cervical muscle group （P〈0.05）. Single factor analysis showed that diameter of the tumors, thyroid membrane invasion and central region lymph node metastasis had correlations with venous angle lymph metastasis （P〈0.01）. Logistic regression analysis showed that thyroid membrane invasion （OR=3.539）, central region lymph node metastasis （OR = 1.617）, diameters of the tumors （OR = 1.321）were the risk factors of cervical venous angle lymph node metastasis. Conclusions Patients with tumor diameter equal to or more than 1.5 cm, thyroid membrane invasion and lymph node metastasis number greater than or equal to 2 should be performed with lateral neck lymph node dissection. Also the venous angle lymph node dissection should be done in these patients so as to increase radical rate.
作者
陈焰
朱信强
张明
丁闯
孔令永
Chen Yan Zhu Xinqiang Zhang Ming Ding Chuang Kong Lingyong
出处
《中国医师进修杂志》
2017年第6期522-526,共5页
Chinese Journal of Postgraduates of Medicine
