摘要
目的:探究甲状腺穿刺活检及洗脱液检测在甲状腺癌颈淋巴结清扫手术指导中的应用优势,为指导甲状腺乳头状癌(PTC)患者是否行颈侧区淋巴结清扫术提供依据。方法:回顾性分析承德医学院附属医院甲状腺外科于2018年4月—2019年12月收治的258例甲状腺乳头状癌患者的病例资料。所有患者入院均接受颈部淋巴结超声检查,依据该检查结果表现征象,对出现转移可疑征象患者行甲状腺穿刺活检及穿刺洗脱液检测,检测结果阳性患者及超声初检有转移征象患者接收颈侧区淋巴结清扫术。所有患者术后均行病理学检测,对其淋巴结转移情况进行诊断,评价各检测方法下行颈侧区淋巴结清扫术的患者检测灵敏度、特异度以及检测准确率。计量资料以均数±标准差(Mean±SD)表示,计数资料用例(%)表示。采用SPSS 21.0软件进行统计学分析。结果:258例患者均顺利完成各项诊断方法诊断,结合术后病理学诊断结果,超声诊断淋巴结转移准确率74.42%、FNAC诊断准确率82.95%、FNA-Tg诊断准确率87.98%、FNAC-Tg诊断准确率94.96%;其中超声、FNAC、FNA-Tg、FNAC-Tg诊断灵敏度分别为73.60%、81.72%、91.01%、95.83%,诊断特异度分别为76.25%、86.11%、79.71%、88.41%。以每4个月为一时间跨度,从2018年4月起,每一跨度患者平均住院时间为(9.17±1.30)、(8.39±1.21)、(7.94±1.03)、(7.46±0.94)、(7.33±0.82)d,颈侧区淋巴结转移发病率分别为17.6%、21.3%、15.7%、12.9%、11.8%,颈侧区淋巴结清扫术手术患者占比分别为42.3%、37.5%、30.9%、26.6%、19.4%,颈侧区淋巴结清扫术患者淋巴结转移发病率分别为86.8%、79.4%、84.5%、93.2%、98.1%。结论:FNAC-Tg用于诊断甲状腺乳头状癌患者淋巴结转移灵敏度高、特异性好,对于指导患者是否进行淋巴结清扫术有一定价值。
Objective:To explore the advantage of thyroid biopsy and evaluate detection in the application of thyroid cancer cervical lymph node dissection operation guidance,and provide evidence-based basis for guiding PTC patients whether to receive lateral dissection.Methods:The data of 258 patients with thyroid papillary carcinoma admitted to Department of Thyroid Surgery,Affiliated Hospital of Chengde Medical College from April 2018 to December 2019 were retrospectively analyzed.All patients were admitted to the hospital for ultrasonic examination of cervical lymph nodes.According to the examination results,thyroid biopsy and puncture eluent were performed for patients with suspicious signs of metastasis.Patients with positive test results and with metastatic signs in initial ultrasonic examination received lymph node dissection in the cervical region.All patients underwent pathological examination postoperatively to diagnose the lymph node metastasis,and to evaluate the sensitivity,specificity and accuracy of the detection of the patients with lateral clearance.The measurement data was expressed as mean±standard deviation(Mean±SD),and the count data was expressed as n(%).The software of SPSS21.0 was used to conduct statistical analysis.Results:All 258 patients were successfully completed the diagnosis of various diagnostic methods.Combined with the postoperative pathological diagnosis results,the accuracy rate of ultrasonic diagnosis of lymph node metastasis was 74.42%,the accuracy rate of FNAC diagnosis was 82.95%,the accuracy rate of FNAC-Tg diagnosis was 87.98%,and the accuracy rate of FNAC-Tg diagnosis was 94.96%.The diagnostic sensitivity of ultrasound,FNAC,FNAC-Tg and FNAC-Tg was 73.60%,81.72%,91.01%and 95.83%,respectively,and the diagnostic specificity was 76.25%,86.11%,79.71%and 88.41%,respectively.In every four months for a time span since April 2018,the average length of hospital stay for patients with each span was(9.17±1.30),(8.39±1.21),(7.94±1.03),(7.46±0.94),(7.33±0.82)d,their neck area incidence o
作者
柴吉鑫
张浏阳
李波
薛筠兴
陈泳
敖亚洲
Chai Jixin;Zhang Liwyang;Li Bo;Xue Junxing;Chen Yong;Ao Yazhou(Department of Thyroid Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)
出处
《国际外科学杂志》
2021年第8期538-542,共5页
International Journal of Surgery
