摘要
目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)右侧喉返神经后方淋巴结(lymph node posterior to right recurrent laryngeal nerve,LN-prRLN)转移的相关危险因素,分析手术清扫LN-prRLN的临床价值。方法回顾分析2014年6月至2015年10月同一治疗组收治的140例PTC患者的临床资料(均行LN-prRLN区清扫,观察组),采用单因素分析及多因素Logistic回归分析LN-prRLN转移的高危因素,同时收集另外171例未行LN-prRLN区清扫(对照组)病例资料作为对照,对比右侧中央区淋巴结清扫的淋巴结总数,分析LN-prRLN区淋巴结转移率及相关危险因素。结果观察组140例中,右颈淋巴结转移率为64.3%(90/140),中央区淋巴结转移率63.6%(89/140),LN-prRLN区域淋巴结转移率17.9%(25/140)。单因素分析显示:肿瘤>1 cm、肿瘤多发、包膜侵犯、临床淋巴结分期cN1、Ⅵ-1区及颈侧区淋巴结转移与LN-prRLN转移有相关性(P<0.05)。多因素分析显示:包膜侵犯(OR=4.599,P=0.037)及颈侧区淋巴结转移(OR=3.505,P=0.036)是LN-prRLN转移的危险因素。对照组的右侧中央区淋巴结清扫总数(10.9±6.1 vs 5.3±3.6)枚和中央区淋巴结转移率(63.6%vs 45.4%)低于观察组,差异有统计学意义(P<0.05)。结论PTC患者右侧中央区淋巴结转移率高且LN-prRLN区淋巴结转移占比大,应常规清扫LN-prRLN来保证清扫的完整性与彻底性,最大程度降低术后因残余淋巴结复发转移而行二次手术的可能。当肿瘤>1 cm、肿瘤多发、包膜有侵犯、临床淋巴结分期cN1、Ⅵ-1区及颈侧区淋巴结转移时,更应当重视LN-prRLN的清扫。
Objective To investigate the risk factors associated with lymph node posterior to right recurrent laryngeal nerve(LN-prRLN)metastasis in papillary thyroid carcinoma(PTC),and analyze the clinical value of surgical dissection of LN-prRLN.Methods Clinical data of 140 PTC patients admitted to the same treatment group from Jun.2014 to Oct.2015(all patients underwent LN-prRLN area dissection,group A)were retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were used to analyze high-risk factors for LN-prRLN metastasis,and another 171 cases without LN-prRLN area dissection(group B)were collected as the control group.The total number of lymph nodes dissected in the central area on the right was compared to analyze the proportion of lymph nodes in the LN-prRLN area.Results Of the 140 patients in group A,the right cervical lymph node metastasis rate was 64.3%(90/140),the central zone lymph node metastasis rate was 63.6%(89/140),and the LN-prRLN regional lymph node metastasis rate was 17.9%(25/140).Univariate analysis showed that tumors>1 cm,multiple tumors,capsule invasion,clinical lymph node staging cN1,VI-1 and cervical lymph node metastasis were correlated with LN-prRLN metastasis(P<0.05).Multivariate analysis showed that capsule invasion(OR=4.599,P=0.037)and cervical lymph node metastasis(OR=3.505,P=0.036)were risk factors for LN-prRLN metastasis.By comparison with the control group,the total number of lymph node dissections in the right central area of group B was significantly less than that of group A(P<0.01).Conclusions PTC patients have a high rate of lymph node metastasis in the right central area,and lymph nodes in the LN-prRLN area occupy a certain proportion.RN-prRLN should be routinely cleaned to ensure the completeness and thoroughness of the dissection,and to minimize the possibility of performing a second operation due to recurrence of residual lymph nodes after operation.More importance should be attached to LN-prRLN dissection when the tumor is more than 1 cm,the tumor is multiple,the capsule is invaded,in clinical lymph node stage cN1,VI-1 and with cervical lymph node metastasis.
作者
赵朋
朱江
苏新良
何伟
Zhao Peng;Zhu Jiang;Su Xinliang;He Wei(Department of Thyroid Surgery,Binzhou People’s Hospital,Binzhou 256610,China;Department of Endocrinology and Breast Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of General Surgery,Changshou District People’s Hospital of Chongqing,Chongqing 401220,China)
出处
《中华内分泌外科杂志》
CAS
2020年第4期284-289,共6页
Chinese Journal of Endocrine Surgery
基金
重庆市社会事业与民生保障科技创新项目(csts2017shmsA1300066)。
