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目的探讨cN0甲状腺乳头状癌颈淋巴结转移的高危因素。方法回顾性分析北京同仁医院20 09~2015年537例cN0甲状腺乳头状癌的临床资料,统计患者性别、年龄、多发灶、合并桥本甲状腺炎、突破包膜和肿瘤直径。结果 537例cN0甲状腺乳头状癌患者颈淋巴结转移率30.9%(166/537),其中单纯VI区转移率24.95%(134/537),VI区+颈侧转移率5.21%(28/537),单纯颈侧率0.74%(4/537)。卡方检验和多因素logistic回归分析显示颈淋巴结转移与男性、年龄<45岁、突破包膜与肿瘤直径>1 cm有关(P<0.05)。术后17例患者暂时声嘶,1例失访,1例随访1.5年未完全恢复正常。术后61例患者暂时低钙,2例失访,2例分别随访1.5和4年,仍需补钙。结论对cN0甲状腺乳头状癌患者进行危险度分层,男性、年龄<45岁、突破包膜、肿瘤直径>1 cm是颈淋巴结转移的高危因素,建议个体化治疗,行预防性中央区淋巴结清扫。
Objective To investigate the risk factors of cervical lymph node metastasis in cN0 thyroid papillary carcinoma. Methods The clinical data of 537 cases of cN0 papillary thyroid carcinoma in Beijing Tongren Hospital from2009to2015were retrospectively analyzed. The patients’ gender, age, multifocality and Hashimoto’s thyroiditis were statistically analyzed, and the capsule and tumor diameter were broken. Results The metastasis rate of cervical lymph nodes in 537 patients with cN0 thyroid papillary carcinoma was 30.9% (166/537). The metastasis rate of simple lymphatic metastasis was 24.95% (134/537) in VI and 5.21% (28/537) Simple neck rate 0.74% (4/537). Chi-square test and multivariate logistic regression analysis showed that cervical lymph node metastasis was associated with male age <45 years. The breakthrough of the capsule was associated with a tumor diameter> 1 cm (P <0.05). Seventeen patients were temporarily hoarse after operation, one was lost to follow-up, and one patient did not fully return to normal after 1.5 years of follow-up. 61 patients after surgery temporary low calcium, 2 patients were lost, 2 were followed up 1.5 and 4 years, still need calcium. Conclusion The risk stratification of cN0 thyroid papillary carcinoma patients, male, age <45 years, break through the capsule, the tumor diameter> 1 cm is a risk factor for cervical lymph node metastasis, it is recommended that individualized treatment, preventive central lymph node dissection .