甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的：探讨甲状腺乳头状癌颈部淋巴结转移规律及其相关影响因素，为甲状腺乳头状癌颈部淋巴结清扫术提供一定的临床依据。方法：回顾性分析314例甲状腺乳头状癌患者的临床资料。314例患者中，行甲状腺腺叶峡部切除、中央区淋巴结清扫术79例，甲状腺全切、中央区淋巴结清扫术173例，甲状腺全切、中央区淋巴结清扫术、侧颈部改良根治性颈部淋巴结清扫术62例。手术中清扫出淋巴结1～55个，其中阳性淋巴结0～14个。结果：314例患者中经病理证实共有168例（53．50％）患者有淋巴结转移，其中中央区淋巴结转移159例（50．64％），中央区＋侧颈转移淋巴结55例（17．52％），单纯侧颈淋巴结转移9例（2．87％）。患者年龄、肿瘤直径、甲状腺被膜受侵犯、临床分期是甲状腺乳头状癌颈部淋巴结转移的影响因素（P〈0．05）。结论：甲状腺乳头状癌患者最常发生中央区淋巴结转移，应常规进行中央区淋巴结清扫术。

Metastatic pattern and influencing factors of cervical lymph node in papillary thyroid carcinoma

Objective： To study the metastatic patterns of cervical lymph node in papillary thyroid carcinoma and their relevant influencing factors, aiming to provide clinical evidence for neck lymph node dissection in patients with PTC. Method： Three hundred and fourteen patients with papillary thyroid carcinoma were collected in this retrospective study. Seventy-nine cases in 314 cases received thyroid lobectomy plus isthmusectomy and central lymph node dissection; 173 cases total thyroidectomy and central lymph node dissection; and 62 cases total thy- roidectomy, central lymph node dissection and modified lateral neck dissection. The number of lymph node cleaned in the operation was 1- 55 in each patient and the number of positive lymph node was 0-14. Result： One hundred and sixty-eight cases in 314 patients with PTC （53.50 %）were pathologically confirmed with lymph node metasta- sis. Among them, 159 cases（50.64%） were confirmed with central lymph node metastasis, 55 cases （17.52%） with central plus lateral lymph node metastasis, and 9 cases（2.87%） merely with lateral lymph node metastasis. The age of patients, diameter of primary tumor, invasion of thyroid capsule, and clinical staging are the influence factors of cervical lymph node metastasis in PTC patients （P〈0.05）. Conclusion： Papillary thyroid carcinoma presents the highest rate of central lymph node metastasis, therefore central lymph node dissection should be routinely performed.