中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (06): 708-713.DOI: 10.19538/j.cjps.issn1005-2208.2023.06.20

• 论著 • 上一篇    下一篇

甲状腺乳头状癌右侧喉返神经深方淋巴结转移危险因素分析

孙一心1，2，王朝晖2，陈    锦2，陈义波2，万全鑫2，张维静1，2，张亚萍1，2   

  1. 1电子科技大学医学院，四川成都610054，2四川省肿瘤临床医学研究中心   四川省肿瘤医院·研究所   四川省癌症防治中心   电子科技大学附属肿瘤医院甲状腺-耳鼻咽喉头颈外科，四川成都610041
  • 出版日期:2023-06-01 发布日期:2023-06-17

  • Online:2023-06-01 Published:2023-06-17

摘要： 目的    探讨甲状腺乳头状癌（PTC）右侧喉返神经深方淋巴结（LN-prRLN）转移的危险因素，为LN-prRLN清扫决策提供参考依据。方法    回顾性分析2021年7月至2022年1月四川省肿瘤医院甲状腺-耳鼻咽喉头颈外科收治的901例PTC病人的临床资料，其中行LN-prRLN清扫213例；对病人的人口学特征、术前甲状腺功能、彩超影像学特征、病理特征与LN-prRLN转移的关系进行单因素、多因素Logistics回归分析。结果    213例病人中右侧喉返神经浅面淋巴结（LN-arRLN）转移96例（45.1%），LN-prRLN转移41例（19.2%）。单因素分析：年龄、性别、侧方淋巴结转移（LLNM）、结外侵犯、腺外侵犯、癌灶直径≥10 mm、不合并结节性甲状腺肿（NG）、LN-arRLN转移、喉前淋巴结转移、左中央区淋巴结转移、血清游离三碘甲状腺原氨酸（FT3）＞4.41 pmol/L与LN-prRLN转移相关；多因素分析：LLNM、腺外侵犯、不合并NG、LN-arRLN转移、FT3＞4.41 pmol/L是LN-prRLN转移的独立危险因素。结论    当伴有LLNM、伴有LN-arRLN转移、肿瘤腺外侵犯、不合并NG、术前甲状腺功能检查显示FT3＞4.41 pmol/L时，应考虑行LN-prRLN清扫。

关键词: 甲状腺乳头状癌, 右侧喉返神经深方淋巴结, 危险因素

Abstract: Predictive factors of metastasis of lymph node posterior to the right recurrent laryngeal nerve in papillary thyroid cancer         SUN Yi-xin*, WANG Chao-hui, CHEN Jin, et al.  * School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Medical Research Center for Tumors, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Thyroid-Ear Nose Pharynx Head and Neck Surgery Department of Affiliated Tumor Hospital of University of Electronic Science and Technology of China, Chengdu 610054, China
Corresponding author: WANG Zhao-hui,E-mail:wangzh912@163.com
Abstract    Objective    To investigate the risk factors for lymph node posterior to the right recurrent laryngeal nerve（LN-prRLN）metastasis in papillary thyroid cancer（PTC）, and to provide a reference for decision-making for LN-prRLN clearance. Methods    901 cases of PTC admitted to the Department of Thyroid-Ear Nose Pharynx Head and Neck Surgery of Sichuan Cancer Hospital from July 2021 to January 2022 were collected, of which 213 cases underwent LN-prRLN dissection. The relationship between patients' demographic features, preoperative thyroid function, ultrasound characteristics, pathological characteristics, and LN-prRLN metastasis was analyzed by univariate and multivariate logistic regression. Results  Among 213 patients,96（45.1%）had metastasis of lymph node anterior to the right recurrent laryngeal nerve（LN-arRLN）, and 41（19.2%）had LN-prRLN metastasis. Univariate analysis showed that age, sex, lateral lymph node metastasis（LLNM）, extranodal invasion, extrathyroid invasion, cancer diameter ≥10 mm, no combined nodular goiter （NG）, LN-arRLN metastasis, laryngeal lymph node metastasis, left central lymph node metastasis and FT3 ＞4.41 pmol/L were related to LN-prRLN metastasis. Multifactorial analysis showed that LLNM, extrathyroid invasion, no combined NG, LN-arRLN metastasis, and FT3 ＞4.41 pmol/L were independent risk factors for LN-prRLN metastasis. Conclusion    Patients with LLNM, LN-arRLN metastases, extrathyroid invasion, FT3 ＞4.41 pmol/L, without combined NG, are suggested to clear LN-prRLN.

Key words: papillary thyroid cancer, lymph node posterior to the right recurrent laryngeal nerve, risk factors