甲状腺乳头状癌合并桥本氏甲状腺炎右侧喉返神经深层淋巴结转移情况分析

目的：探讨甲状腺乳头状癌（PTC）合并桥本氏甲状腺炎（HT）患者右侧喉返神经深层淋巴结（LN-prRLN） 的转移情况。方法： 选取本院2015 年7 月至2019 年12 月收治的123 例PTC合并HT及150 例单纯PTC病例为研究 对象，分为观察组、对照组。所有患者均行中央区淋巴结完整清扫，比较2 组颈部中央区淋巴结转移情况，分析 观察组不同临床病理特征患者LN-prRLN 转移率，采用多因素logistic 回归分析探讨观察组发生LN-prRLN 转移的 独立影响因素。结果：术后病理结果提示观察组、对照组中央区淋巴结转移率、LN-prRLN 转移总转移率、单纯 转移率，分别为43.1%、48.0%，26.8%、30.0%，4.9%、9.3%，2 组比较差异均无统计学意义。单因素分析表明 观察组癌灶最大径>2.0 cm、癌灶数量≥ 2 个、癌灶位于甲状腺下极、肿瘤侵犯包膜、甲状腺周围组织、中央区 淋巴结清扫总数≥ 5 枚、合并其他中央区淋巴结转移、颈侧区淋巴结转移患者LN-prRLN 转移发生率显著升高， 差异均有统计学意义。多因素logistic 回归分析结果表明，癌灶数量≥ 2 个与肿瘤侵犯包膜是观察组LN-prRLN 转 移发生的独立危险因素（OR=1.986、3.338）。结论：1/4 的PTC合并HT患者会出现LN-prRLN 转移，在清扫右侧 中央区淋巴结时应常规探查LN-prRLN，当癌灶数量≥ 2 个与肿瘤侵犯包膜时推荐尽量完整清扫LN-prRLN。

Analysis of metastasis of lymph node posterior to right recurrent laryngeal nerve in patients with papillary thyroid carcinoma and Hashimoto's thyroiditis

Objective To analyze the metastasis of lymph node posterior to right recurrent laryngeal nerve（ LN-prRLN） in patients with papillary thyroid carcinoma （PTC） and Hashimoto's thyroiditis （HT）. Methods 123 patients with PTC and HT and 150 patients with PTC from July 2015 to December 2019 were enrolled the in study as observation group and control group respectively. All cases underwent complete dissection of lymph node， and the metastasis of central compartment lymph node was compared between two groups. The incidence of LN-prRLN metastasis was compared among different patients with clinicopathological features， and multivariate logistic regression analysis was performed to explore the independent risk factors of LN-prRLN m etastasis in observation group. Results Postoperative pathological results showed that the incidence of central compartment lymph node metastasis， total incidence of LNprRLN metastasis， and incidence of alone metastasis of LN-prRLN in observation group and control group were 43.1% and 48.0%， 26.8% and 30.0%， 4.9% and 9.3%， respectively. And there were no statistically significant differences between two groups. Single factor analysis result showed that incidence of LN-prRLN metastasis in patients with tumor maximum diameter > 2.0 cm， tumor number ≥ 2， tumor located in the low part of parathyroid gland， thyroid capsule invasion， peripheral tissue invasion， the dissection number of central compartment lymph node ≥ 5 pieces， combined with significantly increased central compartment lymph node metastasis and lateral lymph node metastases in observation group. Multivariate logistic regression analysis showed that tumor number ≥ 2 and thyroid capsule invasion were the independent risk factors for patients with LN-prRLN metastases in observation group（ OR=1.986， 3.338）. Conclusion LN-prRLN metastases occur in a quarter of patients with PTC and HT， so LN-prRLN should be routinely explored during dissection of central compartment lymph node， and those patients with tumor number ≥ 2 and thyroid capsule invasion are recommended to complete dissection of LN-prRLN.