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目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)患者颈淋巴结转移的临床特点及其相关因素,为颈淋巴结清扫术的选择提供临床依据。方法:对2006年1月—2011年12月在本科接受外科手术的205例PTC合并HT患者颈淋巴结转移的临床特点及相关影响因素进行回顾性分析。这些患者均接受了颈淋巴结清扫术。结果:PTC合并HT患者的颈淋巴结转移率为52.7%(108/205),颈淋巴结转移遵循以中央区为第1站的规律,中央区淋巴结转移率(50.2%,103/205)高于侧颈区淋巴结转移率(15.1%,31/205)(P=0.000)。性别(r=0.009,P=0.904)、术前血清促甲状腺激素水平(r=-0.050,P=0.536)和原发肿瘤病灶数(r=0.119,P=0.096)均与淋巴结转移无明显相关性;年龄(r=-0.140,P=0.043)、原发肿瘤大小(r=0.185,P=0.010)和肿瘤外侵(r=-0.340,P=0.010)均与淋巴结转移相关。结论:鉴于PTC合并HT患者颈中央区淋巴结转移率较高,应常规行中央区淋巴结清扫术;侧颈区淋巴结由于转移假阳性率较高,因此在考虑行淋巴结清扫时应持谨慎态度。对于青少年或年龄≥45岁、原发肿瘤较大以及肿瘤外侵的患者,可酌情考虑Ⅰ期行侧颈区淋巴结清扫术。
Objective: To investigate the clinical characteristics and related factors of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC) combined with Hashimoto’s thyroiditis (HT) and to provide a clinical basis for the selection of cervical lymph node dissection. Methods: The clinical features and related factors of cervical lymph node metastasis in 205 PTC patients with HT undergoing surgery from January 2006 to December 2011 were analyzed retrospectively. All of these patients underwent cervical lymph node dissection. Results: The rate of cervical lymph node metastasis in PTC patients with HT was 52.7% (108/205). The cervical lymph node metastasis followed the rule of the central region as the first station. The rate of lymph node metastasis in central area (50.2%, 103/205) was higher than that in PTC Cervical lymph node metastasis rate (15.1%, 31/205) (P = 0.000). Preoperative serum thyrotropin (r = -0.050, P = 0.536) and primary tumor size (r = 0.119, P = 0.096) had no significant correlation with lymph node metastasis (r = 0.009, P = 0.904) The age (r = -0.140, P = 0.043), primary tumor size (r = 0.185, P = 0.010) and tumor invasion (r = -0.340, P = 0.010) were all associated with lymph node metastasis. CONCLUSIONS: In view of the high rate of lymph node metastasis in the central neck region of PTC patients with HT, central lymphadenectomy should be routinely performed. Because of the high false positive rate of metastatic lymph nodes in lateral neck region, caution should be taken when considering lymphadenectomy. For adolescents or ≥45 years of age, the primary tumor and tumor invasion of patients, may be considered, as appropriate, Ⅰ lateral neck lymph node dissection.