分化型甲状腺癌颈中央区淋巴结转移相关因素研究-外科学(腺体)专业论文.docx

上海交 上海交通大学医学院硕士论文 万方数据 万方数据 中文摘要 目的：探讨分化型甲状腺癌颈中央区淋巴结转移的风险因素，判断其与颈中央 区淋巴结转移的相关性。试图找出分化型甲状腺癌的风险因素，从而决定是否行预 防性颈中央区淋巴结清扫术。 方法：回顾性分析上海交通大学医学院附属新华医院普外科 2011 年 8 月至 2014 年 2 月期间收治的初发 cN0 分化型甲状腺癌患者的病例资料，分别记录性别、诊断 年龄、肿瘤最大径、病变腺叶、肿瘤单发或多发、肿瘤位于单叶或双叶、包膜浸润、 颈中央区淋巴结病理、T 分期、TNM 分级、是否合并桥本氏甲状腺炎、血清 Tg-Ab 水平、血清 TPO-Ab 水平、血清 TSH 水平等，进行单因素及多因素分析。 结果：肿瘤最大径是 cN0 分化型甲状腺癌患者颈中央区淋巴结转移的风险因素； 而合并桥本氏甲状腺炎是 cN0 分化型甲状腺癌患者颈中央区淋巴结转移保护因素。 肿瘤最大径是 cN0 分化型甲状腺癌患者颈中央区淋巴结转移的独立预测因素，而性 别、诊断年龄、肿瘤单发或多发、肿瘤位于单叶或双叶、是否包膜浸润、血清 Tg-Ab、 血清 TPO-Ab、血清 TSH 水平等不是颈中央区淋巴结转移的独立预测因素。 结论：对于 cN0 分化型甲状腺癌患者应常规行预防性颈中央区淋巴结清扫术。 关键词：分化型甲状腺癌，颈中央区淋巴结，预防性颈淋巴结清扫术，转移风 险因素 I Abstract Purpose：To explore the risk factors of central neck lymph node metastasis in differentiated thyroid cancer, judging the relationship between central lymph node metastasis and those factors, and then try to find out the risk factors of differentiated thyroid carcinoma in order to determine whetherto excute prophylactic central lymph node dissection. Methods ： Retrospective analysis data of General Surgery of Xinhua Hospital affiliated to Shanghai Jiao Tong University, from August 2011 to February 2014, which the patients diagnosed with cN0 differentiated thyroid cancer were compared. Recodegender, age at diagnosis, the maximum diameter of the tumor, pathological lobe, single or multiple tumors, the tumors located in the single lobe or double lobe, capsular invasion, the Pathology of central lymph node,T staging,TNM staging, accompany Hashimotos thyroiditis or not, sTg-Ab level, sTPO-Ab level, sTSH level.Univariate and multivariate analysis are applied to reveal the factors that determine the metastasis of central lymph nodes. Results：the maximum diameter of the tumor is risk factor of central lymph node metastasis,butHashimotos thyroiditis is the protective factors in cN0 patients.The maximum diameter of the tumoris the independent predictors of lymph node metastasis.Gender, age at diagnosis, single or multiple tumors, tumors loc