摘要
目的探讨伴桥本甲状腺炎(HT)的甲状腺乳头状癌(PTC)的临床病理特征及手术策略。方法2016年7月~2020年12月我院收治的PTC病人884例,比较伴HT和不伴HT的PTC病人的临床病理特征;分析伴HT的PTC病人发生中央区淋巴结转移的危险因素。结果伴HT的PTC病人占总PTC病人的30.8%。与不伴HT的PTH病人比较,伴HT的PTC病人女性比例更高,年龄更小,病灶边界不清比例更高,甲状腺包膜受侵比例及中央区淋巴结转移发生率更低,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,低龄、肿瘤最大径大及甲状腺包膜受侵,发生中央区淋巴结转移的风险越大(OR值分别为0.940,1.644,0.434,P值分别为<0.001,0.027,0.012)。受试者工作特征(ROC)曲线分析显示,年龄39.5岁及肿瘤最大径0.525 cm是伴HT的PTC病人中央区淋巴结转移危险因素截点。结论伴HT的PTC多见于年轻女性,其病灶边界不清,甲状腺包膜不易受侵,中央区淋巴结转移发生率更低。手术可行单侧甲状腺及峡部切除或甲状腺全切除,中央区淋巴结清扫可个体化处理,对于年龄小于39.5岁、肿瘤最大径大于0.525 cm、甲状腺包膜受侵的病人建议常规行中央区淋巴结清扫。
Objective To analyze the clinicopathological features and surgical strategy of papillary thyroid carcinoma(PTC)with coexistent Hashimoto’s thyroiditis(HT).Methods The clinical data of 884 patients with papillary thyroid cancer who underwent the first thyroid surgery in the same diagnosis and treatment group of General Surgery Department of Jiangsu Province Hospital of Chinese Medicine from July 2016 to December 2020 were analyzed retrospectively.The clinicopathological features of PTC patients with coexistent HT and PTC patients without HT were compared,and the risk fastors of central lymph node metastasis in PTC patients coexistent HT were analyzed.Results PTC patients with coexistent HT accounted for 30.8%of the total PTC patients.Compared with the PTC patients without HT,PTC patients with coexistent HT had higher proportion of females,younger age,higher proportion of unclear lesion boundary,lower proportion of thyroid capsule invasion and central lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that younger age,larger tumor diameter and thyroid capsule invasion were associated with higher risk of central lymph node metastasis(OR:0.940,1.644,0.434,P:<0.001,0.027,0.012,respectively).Receiver operating characteristic(ROC)curve analysis showed that age of 39.5 years and maximum tumor diameter of 0.525 cm were cut-off points for central lymph node metastasis in PTC patients with coexistent HT.Conclusion PTC with coexistent HT is more common in young women,with unclear boundary,less invasion of thyroid capsule and lower incidence of central lymph node metastasis.Unilateral thyroidectomy and isthmus resection or total thyroidectomy are feasible.Central lymph node dissection can be individualized.For patients younger than 39.5 years old,the maximum diameter of tumor greater than 0.525 cm and thyroid capsule invasion,central lymph node dissection should be routinely performed.
作者
何领
徐鲲
任明
陈晨
郭嵩
朱太阳
陈德轩
高国宇
王高元
HE Ling;Xu Kun;Ren Ming(Department of General Surgery,Afiliated Hospital of Nanjing Uninersity of Chinee Medicine,Nanjing 210029,China)
出处
《临床外科杂志》
2022年第1期40-43,共4页
Journal of Clinical Surgery
关键词
桥本甲状腺炎
甲状腺乳头状癌
临床病理特征
危险因素
外科手术
Hashimoto’s thyroiditis
papillary thyroid carcinoma
clinicopathological features
risk factors
surgical procedure
