甲状腺微小乳头状癌颈侧区淋巴结清扫81例临床剖析.docVIP

甲状腺微小乳头状癌颈侧区淋巴结清扫81例临床剖析 　　DOI：10.16662/j.cnki.1674-0742.2016.32.017 　　[摘要] 目的 探?甲状腺微小乳头状癌颈侧区淋巴结转移的检查方法、危险因素及手术方法。方法 方便选取该院2009年1月―2016年6月收治的81例次行颈侧区淋巴结清扫的甲状腺微小乳头状癌患者进行回顾性病例分析。分析该81例次患者颈侧区淋巴结转移情况及临床资料的相关性。结果 超声对颈侧区淋巴结转移的敏感性约为88.8%、特异性约为56.5%。有被膜浸润的病灶49例次中转移31例次，无被膜浸润的病灶32例次中转移19例次，差异有统计学意义（P=0.002）。对于单灶病变，位于上极的病灶22例次中转移17例次，位于中下极的病灶41例次中转移16例次，差异有统计学意义（P=0.004）。多灶癌18例次中转移7例次，单灶癌转移63例次中转移33例次，差异无统计学意义（P=0.313）。男性25例次中转移15例次，女性56例次中转移25例次，差异无统计学意义（P=0.202）。年龄45岁46例次中转移26例次，年龄≥45岁35例次中转移14例次，差异无统计学意义（P=0.141）。59例次采用颈根部衣领式切口，22例次采用传统的L形切口，前者同样能很好的清扫颈侧区淋巴结，不增加手术并发症，在外观满意度及颈肩部活动度方面均优于后者。 结论 甲状腺微小乳头状癌颈侧区淋巴结转移的问题不容忽视，术前超声等检查可以提供较好的敏感性，但特异性不足。癌灶浸润甲状腺被膜及位于上极可能是甲状腺微小乳头状癌颈侧区淋巴结转移的危险因素。 　　[关键词] 甲状腺微小乳头状癌；颈侧区；淋巴结清扫；危险因素 　　[中图分类号] R73 [文献标识码] A [文章编号] 1674-0742（2016）11（b）-0017-03 　　Clinical Analysis of 81 Cases of Lateral Neck Lymph Node Dissection in Papillary Thyroid Microcarcinoma 　　XU Li ，LIN，Xiao-lei ，CAI Ming-zhi 　　Zhangzhou City， Fujian Hospital General Surgery Second Department， Zhangzhou， Fujian Province，363000 China 　　[Abstract] Objective To investigate the check method， risk factor and operation method of the lymph node metastasis in lateral neck of papillary thyroid microcarcinoma.Methods Convenient selection retrospective case analysis was performed on 81 cases from January 2009 to June 2016 with papillary thyroid microcarcinoma which had underwent lateral neck lymph node dissection.To analyze the correlation between the lateral neck lymph node metastasis and the clinical data in these cases.Results The sensitivity of ultrasound to the lymph node metastasis of lateral neck was about 88.8%， and the specificity was about 56.5%.31 caess had metastasis in 49 cases of extracapsular invasion， and 9 caess had metastasis in 32 cases of no extracapsular invasion.The difference was statistically significant （P=0.002）.To single lesion cases，7 caess had metastasis in 22 cases located in the upper third of the thyroid lobe，and 16 cases had metastasis in 41 cases located i