微小乳头状癌淋巴结转移及预防性淋巴结清扫的价值

目的探讨微小乳头状癌颈侧区淋巴结转移的危险因素及预防性清扫的价值。方法选取2010年2月至2016年2月收治的172例甲状腺微小乳头状癌患者进行回顾性分析,根据颈淋巴结分区有92例淋巴结转移阴性患者,其中50例采取了预防性单侧或双侧淋巴结清扫(预防组),42例未行预防性淋巴结清扫(未预防组),比较两组预后。应用SPSS 19.0进行分析,住院时间等计量资料用均数±标准差(x珋±s)表示,比较采用独立样本t检验;性别、年龄、肿瘤大小、包膜浸润、侧别、肿瘤位置、肿瘤数目、中央区转移、并发症发生率、肿瘤局部复发或远处转移率、病死率等计数资料计算构成比(%),采用χ2检验;危险因素的预测采用多因素Logical回归,P0.05为差异有统计学意义。结果颈侧区淋巴结转移阳性患者中年龄≤45岁、肿瘤0.5~1.0 cm、包膜浸润、肿瘤位于甲状腺上极、中央区转移者占67.5%、72.5%、45.0%、87.5%、67.5%,均高于阴性患者(P0.05)。中央区转移、肿瘤位于甲状腺上极为颈侧区淋巴结转移的危险因素。预防组患者随访期间未见肿瘤局部复发、远处转移与死亡情况,未预防组病死率2.4%(P0.05),肿瘤局部复发或远处转移率为9.5%(P0.05)。结论肿瘤位于甲状腺上极、存在中央区转移的微小乳头状癌患者更易出现颈侧区淋巴结转移。颈侧区淋巴结转移阴性患者行预防性淋巴结清扫术可有效改善远期预后,且术后并发症未明显增加。

Clinical factors for lateral cervical lymph node metastasis of papillary microcarcinoma and the value of prophylactic lymph node dissection

Objective To investigate the risk factors for lateral cervical lymph node metastasis of papillary microcarcinoma and the value of prophylactic lymph node dissection.Methods The clinical data of 172 patients with papillary thyroid carcinoma from February 2010 to February 2016 were analyzed retrospectively, the prognosis was compared between the prevention group and the non-prevention group.A total of 92 patients with lymph node metastasis were divided into two groups according to the results of cervical lymph node dissection.Fifty patients underwent prophylactic unilateral or bilateral lymphadenectomy (prophylaxis group) and 42 patients without prophylactic lymphadenectomy (without prophylaxis).Using SPSS 19.0 for analysis, the measurement data of hospitalization time showed as the mean±standard deviation (±s), compared with independent samples t test;the count data ofgender, age, tumor size, infiltration of the capsule, side, tumor location, tumor number, central metastasis, complication rate, tumor recurrence or distant metastasis rate, mortality showed as n(%), Compared with X2 test.Multivariate logistic regression was used to predict the risk factors, P<0.05 was considered statistically significant.Results Among patients with positive lateral cervical lymph node metastasis, patients aged ≤ 45 years old, with 0.5 ~ 1.0 cm tumor, capsule invasion, tumor located in the upper pole of thyroid, and central metastasis accounted for 67.5%, 72.5%, 45.0%, 87.5% and 67.5%, respectively which were higher than those in negative group (P<0.05).Central metastasis and tumor located in the upper pole of thyroid papillary microcarcinoma were the risk factors for lateral cervical lymph node metastasis.There was no local recurrence, distant metastasis or death in the patients in the prevention group,the mortality rate was 2.4% in non-prevention group (P>0.05), local recurrence or distant metastasis rate of tumor was 9.5%(P<0.05).Conclusion Patients whose tumors located in the upper pole of thyroid and papillary microcarcinoma are prone to have lateral cervical lymph node metastasis.The application of prophylactic lymph node dissection in patients with negative lateral cervical lymph node metastasis can effectively improve long-term prognosis of patients, without increasing postoperative complications.There was no local recurrence, distant metastasis or death in the patients in the prevention group,the mortality rate was 2.4% in non-prevention group (P>0.05), local recurrence or distant metastasis rate of tumor was 9.5%(P<0.05).Conclusion Patients whose tumors located in the upper pole of thyroid and papillary microcarcinoma are prone to have lateral cervical lymph node metastasis.The application of prophylactic lymph node dissection in patients with negative lateral cervical lymph node metastasis can effectively improve long-term prognosis of patients, without increasing postoperative complications.