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甲状腺乳头状癌侧颈淋巴结转移规律及危险因素分析

发布时间:2018-06-15 06:21

  本文选题:跳跃性转移 + 颈淋巴结转移规律 ; 参考:《吉林大学》2016年硕士论文


【摘要】:目的:探讨甲状腺乳头状癌侧颈淋巴结转移的规律以及影响因素,从而指导临床行侧颈清扫术。方法:总结2013年1月至2015年11月于我科因行全甲加多功能保留颈清扫术的PTC共计247例住院病例。患者纳入标准:病例资料完善,均行多功能保留颈清扫术且术后石蜡病理明确诊断为甲状腺乳头状癌。统计分析侧颈区的转移规律及危险因素和颈部超声的诊断价值。结果:247例患者中,男女比例为81:166(1:2.04),患者年龄9-74岁(42.63±10.59岁)。原发灶直径0.4-9.0cm;单叶病变122例,双叶病变125例。侧颈区阳性205例,颈部各分区所占比例依次为III区(73.7%)、IV区(60.6%)、II区(53.6%)和V区(13.7%)。单区转移71例,多区转移134例。其中VI区未转移而侧颈转移,即跳跃性转移为24例,结果显示年龄大于45岁及肿瘤位置在上部或中部与跳跃性转移率有关系。经过单因素和多因素回归分析显示,中央区淋巴结阳性是侧颈淋巴结转移的危险因素。中央区阳性个数与侧颈区转移率相关的ROC曲线下面积为0.771,其诊断准确性为中等。当中央区阳性个数大于等于3个,判断侧颈区转移的约登指数最大。当中央区阳性个数大于等于5个,多区转移的比例增加。超声对于侧颈区转移的敏感性较高,特异性不高,各可疑的超声特点具有良好的预测侧颈淋巴结转移的作用。可疑特征数目增多时,侧颈区发生转移例数也在增多。结论:1.侧颈区转移以Ⅲ区最多,然后为Ⅳ区和Ⅱ区,V区相对较少。所受累的区域来看,以多区受累比例大。2.跳跃性转移的发生率较低,但年龄大于45岁和肿瘤位于上极或中极要结合术前或术中彩超,警惕跳跃性转移出现。3.侧颈区出现转移的独立危险因素为中央区阳性,并且阳性个数越多,侧颈转移率越高。4.超声对于侧颈淋巴结转移的诊断具有重要作用,随着可疑特征数目增多,其诊断率也相应增加。
[Abstract]:Objective: to investigate the regularity and influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma. Methods: from January 2013 to November 2015, a total of 247 cases of PTC underwent total thyroidism plus multifunctional neck preserving dissection in our department. Patient inclusion criteria: the case data were perfect, all patients underwent multifunctional neck preserving dissection and paraffin wax pathology after operation was clearly diagnosed as papillary thyroid carcinoma. Statistical analysis of the lateral cervical region metastasis and risk factors and the diagnostic value of cervical ultrasound. Results among 247 patients, the ratio of male to female was 81: 166: 2.04, and the age of the patient was 42.63 卤10.59 years old. The diameter of the primary lesion was 0.4-9.0 cm, the single lobe lesion was 122 cases, the double lobe lesion was 125 cases. 205 cases were positive in the lateral cervical area, and the proportion of the cervical regions was 73.73.7in the third region, and 60.6% in the IV area and 53.6% in the second part) and 13.7% in the V area. There were 71 cases of single area metastasis and 134 cases of multi-region metastasis. There were 24 cases of leaping metastasis of lateral neck without metastasis in VI region. The results showed that the age over 45 years old and the location of tumor in the upper or middle part were related to the rate of skip metastasis. Univariate and multivariate regression analysis showed that central lymph node positive was the risk factor of lateral cervical lymph node metastasis. The area under the ROC curve was 0.771and the diagnostic accuracy was moderate. When the number of positive areas in the central region was greater than or equal to 3, the Yorden index of lateral cervical metastasis was the largest. When the positive number of the central region was greater than or equal to 5, the proportion of multi-region metastasis increased. The sensitivity and specificity of ultrasound for lateral cervical lymph node metastasis were high, and the suspicious features of ultrasound had a good predictive effect on lateral cervical lymph node metastasis. When the number of suspicious features increased, the number of metastatic cases in the lateral cervical region was also increasing. Conclusion 1. The metastases of the lateral cervical region were mostly in region 鈪,

本文编号:2021017

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