多灶性甲状腺乳头状癌的临床分析
发布时间：2018-10-11 14:44
【摘要】：目的：多中心性是内分泌肿瘤的共有特点,多灶性甲状腺乳头状癌(multifocal papillary thyroid carcinoma, MPTC)同样较为常见。多发病灶与甲状腺癌的转移情况及预后相关,本课题旨在分析探讨MPTC患者的构成结构及临床特点,为MPTC的诊疗提供一定的理论依据。方法：回顾性分析山东省立医院2012年01月至2013年12月首次接受甲状腺手术且术后石蜡病理确诊为甲状腺乳头状癌的病例404例,按石蜡病理癌灶个数分组,癌灶数=1者为单灶组；癌灶数12者为多灶组。所有数据采用SPSS 19.0统计软件进行分析。结果：在搜集的404例甲状腺乳头状癌患者中,多灶组病例145例,占搜集总PTC病例的35.9%,平均年龄多灶组41.72岁,单灶组44.56岁(T检验P=0.23)。术前甲状腺彩超提示钙化者多灶组85.5%(124例)较单灶组59.5%(154例)高(x2=29.411,P=0.000)；多灶组男性患者所占比例22.1%(32例)较单灶组男性患者所占比例8.9%(23例)高(x2=13.749,P=0.000)；术后病理有淋巴结转移者多灶组50.3%(73例)较单灶组31.7%(82例)高(x2=13.724,P=0.000)；病灶有周围组织侵犯者多灶组29.7%(43例)高于单灶组12.4%(32例)(x2=18.403,P=0.000)；合并结节性甲状腺肿者比例多灶组38.6%(56例)较单灶组43.6%(113例)低(x2=0.958,P=0.328)；合并桥本氏甲状腺炎者比例多灶组29.7%(43例)较单灶组30.9%(80例)低(x2=0.067,P=0.796)；微小乳头状癌比例多灶组46.9%(68例)较单灶组55.2%(143例)低(x2=2.576,P=0.108)；所有404例PTC患者中,是否合并结节性甲状腺肿与是否合并桥本氏甲状腺炎对淋巴结转移率并无显著影响。在145例MPTC患者中,病灶数=2者93例(43.1%),病灶数2者52例(56.9%)；病灶位于单侧者47例(32.4%),位于双侧者98例(67.6%)；微小乳头状癌68例(46.9%),非微小乳头状癌77例(53.1%)。多灶组中病理类型为微小乳头状癌者淋巴结转移率(38.2%)明显低于非微小乳头状癌者(61.0%)(x2=7.556,P=0.006)；病灶位于单侧还是双侧以及病灶个数是否大于2个对淋巴结转移率的影响无统计学意义。结论：甲状腺乳头状癌患者中,多灶组病灶钙化出现率明显高于单灶组；多灶组男性患者比例高于单灶组,因此,在男性PTC患者的诊疗中,更应注意病变的多灶性,以免漏诊；多灶组周围组织侵犯率及淋巴结转移率明显高于单灶组,因此在行MPTC患者手术时,即使术前颈部淋巴结超声未提示有淋巴结转移时,依旧建议同时行中央组淋巴结清扫术；此外,在甲状腺乳头状癌患者中,多灶组和单灶组在发病年龄、肿瘤大小、是否合并结节性甲状腺肿及是否合并桥本氏甲状腺炎上无统计学差异,说明其可能不是影响MPTC发病的因素。在MPTC患者中2个以上病灶者占大多数,病灶位于双侧者多于单侧发病者；但二者对淋巴结转移率的影响无统计学意义。病灶直径大于1cm者比病灶直径小于1cm者淋巴结转移率明显增高。因此,对肿瘤直径较大者而超声未提示有淋巴结转移者,同样建议行甲状腺全切+中央组淋巴结清扫术,并根据病理酌情扩大清扫范围。
[Abstract]:Objective: Multicenter is a common characteristic of endocrine tumor, and multi-focal thyroid papillary carcinoma (MPTC) is also common. The aim of this study is to analyze the structure and clinical characteristics of MPTC, and provide some theoretical basis for diagnosis and treatment of MPTC. Methods: A retrospective analysis of 404 cases of thyroid papillary carcinoma was performed from January 2012 to December 2013 in Shandong province from January 2012 to December 2013. All data were analyzed using SPSS 19. 0 statistical software. Results: Among 404 cases of thyroid papillary carcinoma, 145 cases were selected, accounting for 35. 9% of total PTC cases, 41. 72 years old and 44. 56 years old (T test P = 0. 23). The preoperative thyroid color Doppler ultrasound indicated that there were 85.5% (124 cases) of patients with calcification and 59.5% (154 cases) higher (x2 = 29. 411, P = 0. 000). The proportion of male patients in multi-range group was 22. 1% (32 cases), which was 80.9% (23 cases) higher than that in single-range group (x2 = 13.749, P = 0.000). There were 50.3% (73 cases) of patients with lymph node metastasis after operation, and 31.7% (82 cases) were higher (x2 = 13.724, P = 0. 000). There were 29. 7% (43 cases) of the lesions around the lesion were higher than that in the single range group (12.4% (32 cases) (x2 = 18. 403, P = 0. 000); 32.6% (56 cases) of the group with nodular goiter were lower (x2 = 0.9958) than that in the single range group (40.6%) (113 cases). P = 0. 328); 29. 7% (43 cases) of the proportion of multi-focus group in the patients with thyroiditis were lower (x2 = 0.067, P = 0.796). The proportion of micropapillary carcinoma was 46. 9% (68 cases) than that in the single range group (55.2% (143 cases) (x2 = 2.576, P = 0. 108); all 404 PTC patients, Whether it was combined with nodular goiter had no significant effect on the rate of lymph node metastasis. Among 145 patients with MPTC, the number of lesions = 2, 93 (43. 1%), 52 cases (56. 9%), and 47 cases (36.4%) in one side, 98 cases (66.7%) in double side, 68 cases (46. 9%) of micropapillary carcinoma, 77 cases of non-small papillary carcinoma (53. 1%). The lymph node metastasis rate (38. 2%) in the multi-focal group was significantly lower than that of non-small papillary carcinoma (61.0%) (x2 = 7. 556, P = 0. 006), and whether the lesion was located on one side or the double side and whether the number of lesions was greater than 2 had no statistical significance on the lymph node metastasis rate. Conclusion: In patients with thyroid papillary carcinoma, the occurrence rate of calcification of focal lesion in multi-range group is significantly higher than that of single-range group, and the proportion of male patients in multi-range group is higher than that of single-range group. Therefore, in diagnosis and treatment of male PTC patients, more attention should be paid to the multi-range of lesions, so as to avoid missed diagnosis. The incidence of tissue invasion and lymph node metastasis in multi-range group were significantly higher than that in single range group. Therefore, in patients undergoing MPTC, even before operation, lymph node dissection in central group was still suggested, and in patients with papillary thyroid carcinoma, There was no statistical difference in the age of onset, size of tumor, whether it was combined with nodular goiter and whether it was combined with the thyroiditis of patients with multiple foci and single foci, suggesting that it may not affect the pathogenesis of MPTC. In MPTC patients, 2 or more lesions accounted for most of the lesions, and the lesions were located on more than one side of the two sides; however, the effect of the two lesions on lymph node metastasis was not statistically significant. The diameter of lesion was larger than that of 1cm, and the rate of lymph node metastasis was significantly higher than that of 1cm. Therefore, no lymph node metastasis was suggested to the larger diameter of the tumor, and it was suggested that the lymph node dissection in the central group should be performed in the whole thyroidectomy + central group, and the scope of the dissection should be expanded as appropriate.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.1
本文编号：2264453
[Abstract]:Objective: Multicenter is a common characteristic of endocrine tumor, and multi-focal thyroid papillary carcinoma (MPTC) is also common. The aim of this study is to analyze the structure and clinical characteristics of MPTC, and provide some theoretical basis for diagnosis and treatment of MPTC. Methods: A retrospective analysis of 404 cases of thyroid papillary carcinoma was performed from January 2012 to December 2013 in Shandong province from January 2012 to December 2013. All data were analyzed using SPSS 19. 0 statistical software. Results: Among 404 cases of thyroid papillary carcinoma, 145 cases were selected, accounting for 35. 9% of total PTC cases, 41. 72 years old and 44. 56 years old (T test P = 0. 23). The preoperative thyroid color Doppler ultrasound indicated that there were 85.5% (124 cases) of patients with calcification and 59.5% (154 cases) higher (x2 = 29. 411, P = 0. 000). The proportion of male patients in multi-range group was 22. 1% (32 cases), which was 80.9% (23 cases) higher than that in single-range group (x2 = 13.749, P = 0.000). There were 50.3% (73 cases) of patients with lymph node metastasis after operation, and 31.7% (82 cases) were higher (x2 = 13.724, P = 0. 000). There were 29. 7% (43 cases) of the lesions around the lesion were higher than that in the single range group (12.4% (32 cases) (x2 = 18. 403, P = 0. 000); 32.6% (56 cases) of the group with nodular goiter were lower (x2 = 0.9958) than that in the single range group (40.6%) (113 cases). P = 0. 328); 29. 7% (43 cases) of the proportion of multi-focus group in the patients with thyroiditis were lower (x2 = 0.067, P = 0.796). The proportion of micropapillary carcinoma was 46. 9% (68 cases) than that in the single range group (55.2% (143 cases) (x2 = 2.576, P = 0. 108); all 404 PTC patients, Whether it was combined with nodular goiter had no significant effect on the rate of lymph node metastasis. Among 145 patients with MPTC, the number of lesions = 2, 93 (43. 1%), 52 cases (56. 9%), and 47 cases (36.4%) in one side, 98 cases (66.7%) in double side, 68 cases (46. 9%) of micropapillary carcinoma, 77 cases of non-small papillary carcinoma (53. 1%). The lymph node metastasis rate (38. 2%) in the multi-focal group was significantly lower than that of non-small papillary carcinoma (61.0%) (x2 = 7. 556, P = 0. 006), and whether the lesion was located on one side or the double side and whether the number of lesions was greater than 2 had no statistical significance on the lymph node metastasis rate. Conclusion: In patients with thyroid papillary carcinoma, the occurrence rate of calcification of focal lesion in multi-range group is significantly higher than that of single-range group, and the proportion of male patients in multi-range group is higher than that of single-range group. Therefore, in diagnosis and treatment of male PTC patients, more attention should be paid to the multi-range of lesions, so as to avoid missed diagnosis. The incidence of tissue invasion and lymph node metastasis in multi-range group were significantly higher than that in single range group. Therefore, in patients undergoing MPTC, even before operation, lymph node dissection in central group was still suggested, and in patients with papillary thyroid carcinoma, There was no statistical difference in the age of onset, size of tumor, whether it was combined with nodular goiter and whether it was combined with the thyroiditis of patients with multiple foci and single foci, suggesting that it may not affect the pathogenesis of MPTC. In MPTC patients, 2 or more lesions accounted for most of the lesions, and the lesions were located on more than one side of the two sides; however, the effect of the two lesions on lymph node metastasis was not statistically significant. The diameter of lesion was larger than that of 1cm, and the rate of lymph node metastasis was significantly higher than that of 1cm. Therefore, no lymph node metastasis was suggested to the larger diameter of the tumor, and it was suggested that the lymph node dissection in the central group should be performed in the whole thyroidectomy + central group, and the scope of the dissection should be expanded as appropriate.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.1
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