甲状腺微小癌颈部中央区淋巴结超声表现及转移影响因素分析

发布时间：2018-03-12 16:26

  本文选题：甲状腺微小癌　切入点：淋巴结转移　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.甲状腺微小癌颈部中央区肿大淋巴结超声声像图特征。2.超声对颈中央区各亚区(气管旁、气管前、喉前)淋巴结的检出率。3.甲状腺微小癌颈部中央区淋巴结转移相关影响因素分析。方法:选取2013年1至2015年12月于我院体检或住院超声检查发现甲状腺可疑肿物并行手术治疗,术后经病理证实为甲状腺微小癌患者422例,对颈部中央区淋巴结的超声、术中及病理诊断结果进行对照,总结颈部中央区淋巴结的超声表现,采取单因素和多因素方法分析甲状腺微小癌颈部中央区淋巴转移的相关影响因素。结果:422例甲状腺微小癌患者超声检出颈部中央区气管旁128例(30.3%,128/422)276个肿大淋巴结,其中多数淋巴结(98.6%,272/276)超声表现为低回声、长短径比≥2(63.8%,176/276)、部分淋巴门结构不清(72.1%,199/276)、血流稀少或无血流显示(91.7%,253/276)。术中清扫检出气管旁淋巴结978个,其中522个(53.4%,522/978)淋巴结长径≤5.0 mm;术后经病理检查气管旁淋巴结100例(23.7%,100/422)203个发生转移。颈中央区气管前及喉前淋巴结超声未检出,术中清扫发现气管前和喉前51个肿大淋巴结(气管前22例48个肿大淋巴结,喉前3例3个肿大淋巴结);其中30个淋巴结(58.8%,30/51)长径≤5.0 mm,5个(9.8%,5/51)淋巴结长径10.0 mm;病理检查显示气管前7例13个发生淋巴转移(气管旁及气管前4例同时发生转移),喉前1例1个淋巴转移(与气管旁同时发生转移)。即病理诊断颈中央区淋巴结103例发生转移(24.4%,103/422)。单因素分析表示年龄45岁(P=0.000)、肿瘤直径(5mm)(P=0.001)、颈侧区淋巴结转移(P=0.000)、多灶(P=0.001)、结节内微钙化(P=0.024)的差异有统计学意义(P均0.05)。而性别(P=0.723)、肿瘤部位(P=0.083)、桥本甲状腺炎(P=0.839)、侵犯被膜(P=0.144)、结节内回声(P=0.443)、结节边界(P=0.586)、结节纵横比1(P=0.345)、血流(P=0.999)与CLN转移差异无统计学意义(P均0.05)。多因素分析表示颈侧区淋巴转移(P=0.000)、多灶(P=0.001)、结节内微钙化(P=0.000)为CLN转移危险因素(P均0.05)。结论:1.甲状腺微小癌颈部中央区肿大淋巴结术前超声具有低回声、长短径比≥2、淋巴门结构不清、血供稀少或无血流等特征。2.甲状腺微小癌患者颈部中央区解剖结构复杂,且颈部中央区各亚区淋巴结所在位置较深,长径较小,超声扫查不仔细易漏诊;术前超声未检出颈部肿大异常的淋巴结不能排除微小淋巴结持续存在或复发的危险。3.侧颈区淋巴转移、多灶、结节内微钙化为颈中央区淋巴转移的危险因素,术前超声扫查甲状腺可疑恶性病灶,并伴有上述超声可疑征象时,应对颈中央区区域仔细扫查(尤其气管前及喉前区域)。
[Abstract]:Objective 1. Ultrasonographic features of enlarged lymph nodes in the central cervical region of thyroid microcarcinoma. 2. Sonographic analysis of subregions of the central cervical region (paratracheal, pretracheal). Analysis of the related factors of lymph node metastasis in the central cervical region of thyroid microcarcinoma methods: from 2013 to December 2015, suspected thyroid neoplasms were detected by ultrasonography in our hospital from 2013 to December 2015. 422 cases of thyroid microcarcinoma were proved by pathology after operation. The results of ultrasonography, intraoperative and pathological diagnosis of the lymph nodes in the central region of the neck were compared, and the ultrasonographic findings of the lymph nodes in the central region of the neck were summarized. Univariate and multivariate methods were used to analyze the related factors of lymphatic metastasis in the central cervical region of thyroid microcarcinoma. Results 128 cases of paratracheal lymph nodes in the central region of thyroid were detected by ultrasound in 422 cases of thyroid microcarcinoma. Most of the lymph nodes showed hypoechoic echo, the ratio of length to diameter 鈮，

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