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目的:分析甲状腺微小乳头状癌发生中央区淋巴结转移的危险因素,探讨中央区淋巴结清扫的必要性。方法:回顾2004-01-2012-05期间手术治疗的85例甲状腺微小乳头状癌患者的临床资料,通过单因素及多因素分析,明确中央区淋巴结转移的危险因素,为选择性地进行中央区淋巴结清扫术提供依据。结果:85例患者均接受了中央区淋巴结清扫术,其中同侧中央区清扫者66例,双侧中央区清扫者19例。3例同期行颈部淋巴结清扫术。33例(38.8%)发生中央区淋巴结转移,3例(3.53%)发生颈侧区淋巴结转移。单因素分析显示:不同性别、年龄组中央区淋巴结转移差异无统计学意义(P>0.05);肿瘤直径大于5mm、甲状腺外侵犯、多中心病灶、双侧病灶及术中探及中央区可疑阳性巴结者,发生中央区淋巴结转移的比例明显增高(P<0.05)。多因素分析显示:肿瘤直径大于5mm(OR=3.862,P<0.05)、甲状腺外侵犯(OR=3.885,P<0.05)是发生中央区淋巴结转移的独立危险因素。结论:甲状腺微小乳头状癌患者肿瘤直径大5mm和(或)甲状腺外侵犯时,发生中央区淋巴结转移的危险性增加,有必要行中央区淋巴结清扫术。
Objective: To analyze the risk factors of central lymph node metastasis in thyroid papillary carcinoma and to explore the necessity of lymph node dissection in the central area. Methods: The clinical data of 85 patients with thyroid papillary thyroid carcinoma undergoing surgery during 2004-01-2012-05 were retrospectively analyzed. Univariate and multivariate analyzes were performed to identify the risk factors for lymph node metastasis in the central area. In order to selectively perform the central area Lymphadenectomy provide the basis. Results: All the 85 patients underwent central lymph node dissection, including 66 cases of ipsilateral central area sweeper and 19 cases of bilateral central area sweeper. Three cases underwent cervical lymph node dissection. 33 cases (38.8%) had central lymph node metastasis, 3 cases (3.53%) had cervical lymph node metastasis. Univariate analysis showed that there was no significant difference in the lymph node metastasis in the central region between different sexes and age groups (P> 0.05). The tumor diameter was more than 5mm, the extrathyroidal invasion, multi-center lesion, bilateral lesion and intraoperative exploration and central suspicious positive The incidence of lymph node metastasis in the central area was significantly higher (P <0.05). Multivariate analysis showed that extra-thyroid invasion (OR = 3.885, P <0.05) was an independent risk factor for central lymph node metastasis when the tumor diameter was greater than 5mm (OR = 3.862, P <0.05) Conclusions: When the diameter of tumor is 5mm and the thyroid is invading, the risk of central lymph node metastasis increases. It is necessary to perform central lymph node dissection.