摘要
目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并桥本甲状腺炎(Hashimoto's thyroiditis,HT)患者颈淋巴结转移的临床特点及其相关因素,为颈淋巴结清扫术的选择提供临床依据。方法:对2006年1月—2011年12月在本科接受外科手术的205例PTC合并HT患者颈淋巴结转移的临床特点及相关影响因素进行回顾性分析。这些患者均接受了颈淋巴结清扫术。结果:PTC合并HT患者的颈淋巴结转移率为52.7%(108/205),颈淋巴结转移遵循以中央区为第1站的规律,中央区淋巴结转移率(50.2%,103/205)高于侧颈区淋巴结转移率(15.1%,31/205)(P=0.000)。性别(r=0.009,P=0.904)、术前血清促甲状腺激素水平(r=-0.050,P=0.536)和原发肿瘤病灶数(r=0.119,P=0.096)均与淋巴结转移无明显相关性;年龄(r=-0.140,P=0.043)、原发肿瘤大小(r=0.185,P=0.010)和肿瘤外侵(r=-0.340,P=0.010)均与淋巴结转移相关。结论:鉴于PTC合并HT患者颈中央区淋巴结转移率较高,应常规行中央区淋巴结清扫术;侧颈区淋巴结由于转移假阳性率较高,因此在考虑行淋巴结清扫时应持谨慎态度。对于青少年或年龄≥45岁、原发肿瘤较大以及肿瘤外侵的患者,可酌情考虑Ⅰ期行侧颈区淋巴结清扫术。
Objective： To investigate the clinical features and related factors of cervical lymph node metastasis of papillary thyroid carcinoma coexistent with Hashimoto’s thyroiditis, and to provide clinical evidence when deciding cervical lymph node dissection. Methods： A total of 205 patients who were diagnosed of papillary thyroid carcinoma coexistent with Hashimoto’s thyroiditis and underwent surgery between January 2006 and December 2011 were enrolled in this study, and a retrospective review of the clinical features and related factors of cervical lymph node metastasis was performed. These patients all underwent a cervical lymph node dissection. Results： The percentage of patients with cervical lymph node metastasis was 52.7% （108/205）, and the first lymph nodes to which lymph from the cancer site was likely to drain were cervical central lymph nodes. The rate of cervical central lymph node metastasis was higher than that of cervical lateral lymph node metastasis [50.2% （103/205） vs 15.1% （31/205）, P ﹦ 0. 000]. The factors of gender （r = 0.009,P = 0.904）, serum thyroid stimulating hormone level before surgery （r = –0.050,P = 0.536） and the number of primary tumor lesions （r = 0.119,P = 0.096） were not correlated with lymph node metastasis, but the age （r = –0.140,P = 0.043）, primary tumor size （r = 0.185,P = 0.010） and extrathyroid extension （r = –0.340,P = 0.010） were correlated with lymph node metastasis. Conclusion： Central lymph node dissection should be carried out as a routine for the reason that papillary thyroid carcinoma coexistent with Hashimoto’s thyroiditis had a higher rate of cervical central lymph node metastasis. Dissection of lateral lymph node should be done prudentially for its higher false positive rate. The dissection of lateral lymph node should be considered to be done at the first time when the patients are diagnosed in childhood and adolescence or aged 45 years or over or have a larger tumor size or extrathyroid extension.
出处
《肿瘤》
CAS
CSCD
北大核心
2012年第10期824-827,共4页
Tumor
关键词
甲状腺肿瘤
癌
乳头状
桥本病
淋巴转移
Thyroid neoplasms； Carcinoma, papillary； Hashimoto disease； Lymphatic metastasis
