中国实用外科杂志

中国实用外科杂志

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cN0甲状腺微小乳头状癌右侧喉返神经浅面及深面淋巴结转移危险因素分析

彭冬梅，晏    晨，苏安平，杜永刚，魏    涛，龚日祥，李志辉，朱精强   

  1. 四川大学华西医院甲状腺外科，四川成都 610041
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

目的    探讨cN0甲状腺微小乳头状癌（PTMC）病人右侧喉返神经浅面（Ⅵa区）及深面（Ⅵb区）淋巴结转移的相关危险因素。方法    回顾性分析2012年1月至2015年2月四川大学华西医院甲状腺乳腺外科治疗的294例初诊cN0 PTMC病人的临床资料。均至少行右侧中央区淋巴结清扫。分析右侧Ⅵa区及Ⅵb区淋巴结转移的相关危险因素。结果  中央区淋巴结转移发生率为40.9%，Ⅵa区为23.5%，Ⅵb区为8.5%。浸润甲状腺被膜与Ⅵa、Ⅵb区淋巴结转移无关。右叶PTMC（193例）肿瘤直径>7 mm、气管前淋巴结转移为Ⅵa区淋巴结转移的独立危险因素，气管前、Ⅵa区淋巴结转移是Ⅵb区淋巴结转移的独立危险因素。左叶PTMC（68例）：无Ⅵb区转移者；气管前、喉前淋巴结转移是Ⅵa区淋巴结转移的独立危险因素（P<0.05）。双叶PTMC（33例）：无Ⅵa、Ⅵb区淋巴结转移相关危险因素。结论    对于cN0 PTMC病人，右叶PTMC直径>7 mm、气管前淋巴结转移，或左叶PTMC气管前、喉前淋巴结转移，建议清扫Ⅵa区淋巴结；右叶PTMC气管前、Ⅵa区淋巴结转移，建议清扫Ⅵb区淋巴结；左叶PTMC一般不发生Ⅵb区转移。

关键词: cN0甲状腺微小乳头状癌, 淋巴结转移, 危险因素

Abstract:

Risk factors of metastasis to lymph nodes anterior and posterior to right recurrent laryngeal nerve in cN0 papillary thyroid microarcinoma        PENG Dong-mei，YAN Chen，SU An-ping，et al. Department of Thyroid Surgery，West China Hospital of Sichuan University，Chengdu 610041，China
Corresponding author：ZHU Jing-qiang，E-mail：zjq-wkys@163.com
Abstract    Objective    To find the possible risk factors of lymph node metastasis (LNM) to the anterior(Ⅵa) and posterior(Ⅵb)to right recurrent laryngeal nerve in papillary thyroid microcarcinoma (PTMC). Methods    The clinical and pathological data of 294 initial treatment cN0 PTMC patients Who underwent at least right central lymph node dissection and conducted by the same surgeon in West China Hospital of Sichuan University from January 2012 to February 2015 were analyzed retrospectively. The related risk factors of level Ⅵa, Ⅵb lympy node metastasis were analyzed. Results    LNM was observed in 40.9% of patients，23.5% for level Ⅵa，and 8.5% for level Ⅵb. Capsule invasion was not related to level Ⅵa, Ⅵb LNM. Right lobe PTMC (193 patients)：Tumor diameter more than 7mm, pretracheal LNM were independent risk factors of level Ⅵa LNM and pretracheal，level Ⅵa LNM were independent risk factors of level Ⅵb LNM. Light lobe PTMC (68 patients)：There was no Ⅵb LNM. Pretracheal, prelaryngeal LNM were correlated to level Ⅵa LNM in univariate analysis (P＜0.05)，and were also independent risk factors of level Ⅵa LNM in multivariate analysis. Both lobe PTMC (33 patients): It’s failed to find related risk factors. Conclusion    In cN0 PTMC patients, right lobe PTMC diameter more than 7 mm or left lobe PTMC patients with pretracheal/prelaryngea LNM are suggested to be conducted level Ⅵa lymph node dissection. Right lobe PTMC patients with pretracheal/prelaryngeal/level Ⅵa LNM are suggested to be conducted level Ⅵb lymph node dissection. Left lobe PTMC patients rardly occurs level Ⅵb LNM.

Key words: cN0 papillary thyroid microcarcinoma, lymph node metastasis, risk factor