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目的探讨甲状腺微小癌(TMC)颈淋巴结转移规律,指导TMC颈淋巴结的恰当处理。方法回顾性分析济南军区总医院1999年1月至2010年5月行颈淋巴结清扫的117例TMC病人颈淋巴结转移情况,分析TMC局部淋巴结转移的特点、影响因素、诊断方法及处理意见。结果淋巴结转移发生率53.8%(63/117)。常见颈部淋巴结转移部位依次为Ⅵ区(47.9%)、Ⅲ区(20.9%)、Ⅳ区(16.5%)、Ⅱ区(6.1%)。随Ⅵ区淋巴结转移个数增多,侧方淋巴结转移递增。肿瘤数目、大小不同淋巴结转移发生率差异有统计学意义(P=0.000,P=0.014)。超声检查判断淋巴结有无转移的敏感性、特异性和准确性分别为19.0%、98.1%和55.5%。术中淋巴结快速病理检查有13.8%假阴性。全组无复发、转移和死亡。结论 TMC区域淋巴结转移发生率较高,应重视术前评估和术中快速活检,掌握TMC淋巴结转移特点,有助采取恰当手术方式,有选择的预防性区域性颈淋巴清扫可为可使病人获益。
Objective To investigate the rule of cervical lymph node metastasis in thyroid microcarcinoma (TMC) and to guide the appropriate treatment of TMC cervical lymph nodes. Methods The cervical lymph node metastasis of 117 TMC patients who underwent neck dissection from January 1999 to May 2010 in Jinan Military General Hospital was retrospectively analyzed. The characteristics, influential factors, diagnosis methods and treatment opinions of local lymph node metastasis of TMC were analyzed. Results The incidence of lymph node metastasis was 53.8% (63/117). Common neck lymph node metastasis sites were Ⅵ (47.9%), Ⅲ (20.9%), Ⅳ (16.5%) and Ⅱ (6.1%). With Ⅵ area increased lymph node metastasis, lateral lymph node metastasis increased. There were significant differences in the incidence of lymph node metastasis between tumor size and size (P = 0.000, P = 0.014). The sensitivity, specificity and accuracy of ultrasound examination in determining the presence or absence of lymph node metastasis were 19.0%, 98.1% and 55.5%, respectively. Intraoperative lymph node rapid pathological examination of 13.8% false negative. The whole group without recurrence, metastasis and death. Conclusions There is a high incidence of lymph node metastasis in TMC. Preoperative evaluation and intraoperative rapid biopsy should be emphasized. The characteristics of TMC lymph node metastasis should be grasped. It is helpful to take appropriate surgical modalities. Preventive regional cervical lymph node dissection beneficial.