摘要
目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结转移特点、相关危险因素及术中送检淋巴结冰冻病理学检查的价值。方法本研究选择2016年6月至2018年6月经过病理明确诊断的PTC患者441例,回顾性分析淋巴结转移的发生率、区域分布,与性别、年龄、肿瘤部位、大小、数量、被膜侵犯、合并疾病的关系,以及术中送检淋巴结阳性率与术后病理的一致性。结果441例PTC患者中男性129例,女性312例,男∶女为1∶2.42,平均年龄42.9(42.9±12.8)岁。PTC肿瘤平均大小为(0.89±0.53)cm。肿瘤位于甲状腺左叶173例(39.2%),右叶176例(39.9%),双侧腺叶均受累92例(20.9%)。306例为单发肿瘤(69.4%),135例为多发肿瘤(30.6%),294例累及甲状腺被膜(66.7%)。PTC患者中合并甲状腺腺瘤34例(7.7%);合并桥本氏甲状腺炎153例(34.7%);合并结节性甲状腺炎28例(6.3%)。PTC总淋巴结转移率为52.8%(233/441),中央区淋巴结转移192例,中央区及颈侧区转移32例,无中央区淋巴结转移仅有颈侧区淋巴结转移9例。颈部淋巴结转移的相关危险因素为肿瘤大小、肿瘤数量、甲状腺被膜受累等因素(P<0.05)。术中送检区域淋巴结与术后病理一致性达84.1%,假阴性率为15.9%。结论甲状腺乳头状癌易出现颈部淋巴结转移。肿瘤大小、肿瘤数量、甲状腺被膜受累等因素是颈部淋巴结转移的高危因素,术中选择性送检淋巴结对中央区淋巴结状态有很高的预测作用。
Objective To investigate the characteristics and risk factors of lymph node metastasis in thyroid papillary carcinoma(PTC)and the value of intraoperative pathological examination of lymph nodes.Methods In this study,441 patients with PTC diagnosed pathologically from June 2016 to June 2018 were selected.The incidence and regional distribution of lymph node metastasis were analyzed retrospectively,and the relationship between lymph node metastasis and gender,age,tumor location,size,number,tumor capsule invasion,and associated diseases were analyzed.The positive rate of lymph node intraoperative biopsy was compared with the consistence with postoperative pathology.Results There were 129 of male,and 312 of female among the 441 PTC patients,and the ratio of male to female was 1∶2.42.The mean age was 42.9(42.9±12.8)years.The mean size of PTC tumor was(0.89±0.53)cm.The tumors were located in the left lobe of thyroid gland in 173 cases(39.2%),in the right lobe in 176 cases(39.9%),and in both lobes in 92 cases(20.9%).Single tumors were found in 306 cases(69.4%),and multiple tumors were found in 135 cases(30.6%);294 cases(66.7%)involved thyroid capsule.Thyroid adenoma was found in 34 patients(7.7%).153 cases(34.7%)were complicated with Hashimoto's thyroiditis,and 28 cases(6.3%)were complicated with nodular thyroiditis.The total lymph node metastasis rate of PTC was 52.8%(233/441).There were 192 cases of lymph node metastasis in central region,32 cases of lymph node metastasis in central region and lateral region of neck,and 9 cases of lymph node metastasis in lateral region of neck without lymph node metastasis in central region.The risk factors of cervical lymph node metastasis were tumor size,tumor number and thyroid capsule involvement(P<0.05).The consistency of regional lymph nodes was 84.1%and the false negative rate was 15.9%.Conclusions Cervical lymph node metastasis is common in papillary thyroid carcinoma.Tumor size,tumor number,thyroid capsule involvements are high risk factors for cervical lymph node metast
作者
王亚军
康骅
滕梁红
赵菁
海涛
张小丽
WANG Ya-jun;KANG Hua;TENG Liang-hong;ZHAO Jing;HAI Tao;ZHANG Xiao-li(Department of General Surgery,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;Department of Pathology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
出处
《中国现代手术学杂志》
2019年第4期264-268,共5页
Chinese Journal of Modern Operative Surgery
关键词
甲状腺乳头状癌
淋巴结转移
危险因素
papillary thyroid carcinoma
lymph node metastasis
risk factors
