甲狀腺微小乳頭狀癌頸側區淋巴結清掃81例臨床分析

DOI：10.16662/j.cnki.1674-0742.2016.32.017

[摘要] 目的 探討甲狀腺微小乳頭狀癌頸側區淋巴結轉移的檢查方法、危險因素及手術方法。方法 方便選取該院2009年1月—2016年6月收治的81例次行頸側區淋巴結清掃的甲狀腺微小乳頭狀癌患者進行回顧性病例分析。分析該81例次患者頸側區淋巴結轉移情況及臨床資料的相關性。結果 超聲對頸側區淋巴結轉移的敏感性約為88.8%、特異性約為56.5%。有被膜浸潤的病灶49例次中轉移31例次，無被膜浸潤的病灶32例次中轉移19例次，差異有統計學意義（P=0.002）。對于單灶病變，位于上極的病灶22例次中轉移17例次，位于中下極的病灶41例次中轉移16例次，差異有統計學意義（P=0.004）。多灶癌18例次中轉移7例次，單灶癌轉移63例次中轉移33例次，差異無統計學意義（P=0.313）。男性25例次中轉移15例次，女性56例次中轉移25例次，差異無統計學意義（P=0.202）。年齡<45歲46例次中轉移26例次，年齡≥45歲35例次中轉移14例次，差異無統計學意義（P=0.141）。59例次采用頸根部衣領式切口，22例次采用傳統的L形切口，前者同樣能很好的清掃頸側區淋巴結，不增加手術并發癥，在外觀滿意度及頸肩部活動度方面均優于后者。 結論 甲狀腺微小乳頭狀癌頸側區淋巴結轉移的問題不容忽視，術前超聲等檢查可以提供較好的敏感性，但特異性不足。癌灶浸潤甲狀腺被膜及位于上極可能是甲狀腺微小乳頭狀癌頸側區淋巴結轉移的危險因素。

[關鍵詞] 甲狀腺微小乳頭狀癌；頸側區；淋巴結清掃；危險因素

[中圖分類號] R73 [文獻標識碼] A [文章編號] 1674-0742（2016）11（b）-0017-03

Clinical Analysis of 81 Cases of Lateral Neck Lymph Node Dissection in Papillary Thyroid Microcarcinoma

XU Li ，LIN，Xiao-lei ，CAI Ming-zhi

Zhangzhou City， Fujian Hospital General Surgery Second Department， Zhangzhou， Fujian Province，363000 China

[Abstract] Objective To investigate the check method， risk factor and operation method of the lymph node metastasis in lateral neck of papillary thyroid microcarcinoma.Methods Convenient selection retrospective case analysis was performed on 81 cases from January 2009 to June 2016 with papillary thyroid microcarcinoma which had underwent lateral neck lymph node dissection.To analyze the correlation between the lateral neck lymph node metastasis and the clinical data in these cases.Results The sensitivity of ultrasound to the lymph node metastasis of lateral neck was about 88.8%， and the specificity was about 56.5%.31 caess had metastasis in 49 cases of extracapsular invasion， and 9 caess had metastasis in 32 cases of no extracapsular invasion.The difference was statistically significant （P=0.002）.To single lesion cases，7 caess had metastasis in 22 cases located in the upper third of the thyroid lobe，and 16 cases had metastasis in 41 cases located in the middle and lower third of the thyroid lobe.The difference was statistically significant （P=0.004）.There was no significant difference between the 7 cases had metastasis in 18 cases with multiple lesions and 33 cases had metastasis in 63 cases with a single lesion （P=0.313）.15 cases had metastasis in 25 cases of male，and 25 cases had metastasis in 56 cases of female，the difference was not statistically significant （P=0.202）.26 cases had metastasis in 46 cases of age < 45 years， 14 cases had metastasis in 35 cases of age≥ 45 years ， there was no statistically significant difference （P=0.141）.59 cases with neck root collar incision， 22 cases with traditional L-shaped incision. The former can also very good cleaning the lateral neck lymph node， not increase complications， in appearance satisfaction and neck and shoulder activity degree are superior to those of the latter.Conclusion The problem of lateral neck lymph node metastasis in papillary thyroid microcarcinoma can not be ignored. Preoperative ultrasonography can provide a good sensitivity， but the specificity is not enough. Tumor extracapsular invasion and loction in the upper third of the thyroid lobe may be the most likely risk factors for lymph node metastasis in lateral neck of papillary thyroid microcarcinoma.

[Key words] Papillary thyroid microcarcinoma； Lateral neck region； Lymph node dissection； Risk factors

甲狀腺微小乳頭狀癌（papillary thyroid microcarcinoma，PTMC）指的是病灶最長徑≤1.0 cm的甲狀腺乳頭狀癌[1]?！?br>