180例甲状腺乳头状癌颈部淋巴结转移的分布规律及相关因素的临床分析

目的 对180例甲状腺乳头状癌颈部淋巴结转移的分布规律及其相关因素进行临床研究和分析。方法 以笔者医院2012年4月～ 2013年10月收治的180例甲状腺乳头状癌患者作为研究对象,对其采取术前定位、术中冷冻病理检查,并与术后颈部清扫结果进行比较分析,对淋巴结转移的分布情况以及患者年龄、肿瘤大小、被膜外侵等因素对其的影响进行分析。结果 各分区淋巴结数及占转移淋巴结比例情况具有统计学差异（P＜0.01）,其中以Ⅵ区转移率最高,达49.84％。患者中年龄＞45岁、伴有多灶病变、中央区淋巴转移3枚以上以及原发灶包膜被侵犯的患者其淋巴结转移率明显增高（P＜0.05）,进一步多因素Logistic回归分析结果表明,原发灶包膜侵犯是甲状腺乳头状癌颈部淋巴结转移的独立危险因素（P＜0.05）。结论 甲状腺乳头状癌颈部淋巴结转移多集中于Ⅱ、Ⅲ、Ⅳ、Ⅵ区,其中以Ⅵ区转移率最高,因此临床行颈清扫术时应着重清扫上述分区,另外原发灶包膜侵犯作为甲状腺乳头状癌颈部淋巴结转移的独立危险因素,可成为判断患者是否颈部淋巴结转移的辅助指标。

Clinical Analysis of the Distribution and Related Factors in 180 Cases of Thyroid Papillary Carcinoma with Cervical Lymph Node Metastasis

Objective To analyze the distribution and related factors in 180 cases of thyroid papillary carcinoma with cervical lymph node metastasis.Methods Totally 180 cases of thyroid papillary carcinoma patients who were treated in our hospital from April 2012 to October 2013 were chosen as the research objects.They were taken locate preoperative,intraoperative frozen pathological examination.The results were compared with postoperative neck cleaning result,and the distribution of lymph node metastasis and the impact of patients＇ age,tumor size,be outside invasion were analyzed.Results The partition number of lymph nodes and the proportion of metastasis lymph node had significant difference （P ＜ 0.01）,of which Ⅵ zone transfer rate was highest to 49.84％.The rate of patients who were older than 45 years,with multifocal lesions,lymph node metastases in central region more than three and with primary focal capsular violated the lymph node metastasis was increased significantly （P ＜ 0.05）,and the multifactorial Logistic regression analysis results showed that the primary focal capsular invasion of thyroid papillary carcinoma was a independent risk factor for cervical lymph node metastasis （P ＜ 0.05）.Conclusion The cervical lymph node metastasis of thyroid papillary carcinoma is more focused on the areas of Ⅱ,Ⅲ,Ⅳ and Ⅵ,of which Ⅵ zone transfer rate is highest,so clinical neck cleaning surgery should focus on cleaning these partitions.The other that primary focal capsular invasion as thyroid papillary carcinoma independent risk factors for cervical lymph node metastasis can be a judge whether patients with cervical lymph node metastasis secondary indicators.