单侧甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素

目的:研究单侧甲状腺乳头状癌(papillary thyroid carcinoma,PTC)对侧中央区淋巴结转移的相关因素及术后并发症情况,为病人制定个体化诊疗方案提供依据。方法:2005年10月至2012年12月我科收治的83例单侧PTC病人,术前发现其对侧中央区淋巴结肿大,回顾分析对侧中央区淋巴结转移的相关因素以及术后并发症情况。本研究所有病人行双侧中央区淋巴结清扫术。结果:中央区淋巴结转移者69例(83.1%),其中双侧中央区淋巴结转移50例(60.2%),患侧中央区淋巴结转移15例(18.1%),对侧中央区淋巴结跳跃式转移4例(4.8%)。多因素分析显示,患侧中央区淋巴结转移(P=0.001,OR=9.540)、不合并桥本甲状腺炎(P=0.043,OR=3.092)是对侧中央区淋巴结转移的危险因素。男性(P=0.026,OR=4.065)、原发灶最大径≥1 cm(P

Risk factors of contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma

Objective To evaluate the risk factors for contralateral central lymph node（LN） metastasis in patients with unilateral papillary thyroid carcinoma （PTC）, as well as the postoperative complications. Methods Data were reviewed retrospectively from 83 patients with unilateral PTC and contralateral central LN enlargement from October 2005 to December 2012 of department of head and neck surgery in Fudan University Shanghai Cancer Center. The bilateral central LN dissection was done for all the patients. Results sixty-nine （83.1%） patients had positive central LN pathologically. There were 50 patients （60.2%） with bilateral central LN metastasis and 4 patients （4.8%） with unilateral contralateral central LN metastasis. Both ipsilateral central LN metastasis （P=0.001, OR=9.540） and without Hashimoto＇s thyroiditis （P=0.043, OR=3.092） were independent risk factors for the metastasis of contralateral central LN metastasis while male （P=0.026, OR=4.065） and tumor size ≥ 1 cm （P〈0.001, OR=19.543） for the metastasis of bilateral central LN. Totally, 82 patients completed clinical follow-up. Hypocalcemia occurred in 14 patients of whom one developed permanent hypoparathyroidism. Seven patients complained permanent hoarseness. Conclusions Bilateral central LN dissection should be recommented for those patients with the risk factors such as male, tumor size ≥ 1 cm and positive ipsilateral central LN metastasis while the coexistance of Hashimoto＇s thyroiditis is a protective factor. Furthermore, it is safe for the experienced surgeons to carry on this operation.