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目的探讨单发甲状腺微小乳头状癌(papillary thyroid micro-carcinoma,PTMC)对侧中央区淋巴结转移的可能危险因素。方法回顾性分析2012年4月至2015年5月我科收治的318例病理确诊为单发PTMC并行“甲状腺全切+双侧中央区淋巴结清扫术”患者的临床病理资料,对侧中央区淋巴结转移的危险因素采用χ2检验单因素分析及logistic回归多因素分析。结果单发PTMC中同侧和对侧中央区淋巴结转移率分别为40.57%(129/318)、9.75%(31/318)。单因素分析结果显示对侧中央区淋巴结转移与癌灶位于甲状腺下份、甲状腺被膜浸润、同侧中央区淋巴结转移及合并结节性甲状腺肿相关(P<0.05),多因素分析结果显示癌灶位于甲状腺下份及同侧中央区淋巴结转移是对侧中央区淋巴结转移的独立危险因素(P<0.05)。结论单发PTMC对侧中央区淋巴结转移率比较低,不应该常规行对侧中央区淋巴结清扫;癌灶位于甲状腺下份或同侧中央区淋巴结有转移者,可考虑行双侧中央区淋巴结清扫。
Objective To investigate the possible risk factors of lymph node metastasis in the central region of single papillary thyroid micro-carcinoma (PTMC). Methods The clinical data of 318 patients with pathologically diagnosed PTMC in our department from April 2012 to May 2015 were analyzed retrospectively. The clinical data of patients undergoing total thyroidectomy plus bilateral central lymph node dissection were analyzed retrospectively. The regional lymph node metastasis risk factors using χ2 test univariate analysis and logistic regression multivariate analysis. Results The rates of lymph node metastases in the ipsilateral and contralateral central regions of single-cell PTMC were 40.57% (129/318) and 9.75% (31/318), respectively. Univariate analysis showed that the lymph node metastasis in the contralateral central area was correlated with the tumor located in the thyroid, infiltration of the thyroid gland, lymph node metastasis in the ipsilateral central area and nodular goiter (P <0.05). Multivariate analysis showed that the foci Lymph node metastasis in the lower thyroid and the ipsilateral central region was an independent risk factor for lymph node metastasis in the contralateral central region (P <0.05). Conclusions The lymph node metastasis rate in the contralateral central region of single PTMC is relatively low and should not be routinely performed in the central contralateral lymph nodes. The lesions located in the thyroid gland or in the central ipsilateral lymph nodes may be considered in the bilateral central lymph node dissection .