摘要目的 探讨乳头状甲状腺癌颈部淋巴结跳跃性转移与临床病理特征的相关性.方法 回顾性分析2014年1月至2016年6月因侧颈淋巴结转移于吉林大学白求恩第一医院甲状腺外科接受手术治疗的272例乳头状甲状腺癌患者的临床资料.男性105例,女性167例;年龄16～73岁,平均年龄(42±8)岁.其中29例(10.7％)合并颈部淋巴结跳跃性转移.通过x2检验和多因素Logistic回归分析研究颈部淋巴结跳跃性转移的相关因素.结果 29例合并颈部淋巴结跳跃性转移的患者中,单区转移16例(55.2％),两区转移6例(20.7％),三区转移7例(24.1％).x2检验结果显示,年龄、肿瘤位置与跳跃性转移的发生密切相关(x2值分别为14.056、21.362,P值均=0.000).多因素Logistic回归分析结果显示,年龄≥45岁(OR=4.318,95％ CI:1.767 ～ 10.552,P=0.001)、微小癌(OR=2.623,95％ CI:1.013～6.795,P=0.047)、肿瘤位于甲状腺腺体上部(OR=11.982,95％ CI:2.533～56.173,P=0.002)是跳跃性转移发生的独立相关因素.结论 年龄≥45岁、微小癌、肿瘤癌灶位于甲状腺上部的乳头状甲状腺癌患者更易发生跳跃性转移.跳跃性转移常为侧颈多区受累.对于此类患者,当侧颈淋巴结肿大时,应适当放宽侧颈淋巴结细针穿刺的适应证.

abstractsObjective To investigate the correlation between skip metastasis of neck lymph node and clinicopathological features in papillary thyroid carcinoma.Methods Totally 272 papillary thyroid carcinoma patients with lateral lymph node metastases who received surgical procedure at Department of Thyroid Surgery,the First Hospital of the Jilin University from January 2014 to June 2016 were analyzed retrospectively.There were 105 male and 167 female patients,aging from 16 to 73 years with a mean age of (42±8) years.There were 29 patients (10.7％) with skip metastasis.And then the correlation between skip metastasis of neck lymph node and clinicopathological features was analyzed by x2 test and multivariate Logistic regression test.Results The rate of skip metastasis in all patients was 10.7％ (29/272).By summarizing the distribution of the lateral lymph nodes about the patients with skip metastasis,16 cases metastasized in single level (55.2％),meanwhile 6 in two levels (20.7％) and 7 in three levels (24.1％).Strong correlation between age,tumor location and skip metastasis was found using x2 test (x2 values were 14.056 and 21.362 respectively,both P values were 0.000).Age (≥45 years) (OR =4.318,95％ CI:1.767 to 10.552,P=0.001),microcarcinoma (OR =2.623,95％ CI:1.013 to 6.795,P=0.047) and the tumor located in the upper of the thyroid (OR=1l.982,95％ CI:2.533 to 56.173,P=0.002) were risk factors to the skip metastasis through multivariable Logistic regression analysis.Conclusions Age ≥45 years old,microcarcinoma or tumor located in the upper part of the thyroid gland was more likely present with skip metastasis.Skip metastases are often involved in the lateral multi-level.Therefore,confronted patients with one of these risk factors,the occurrence of skip metastasis should be awared when the lateral lymph node was large abnormally.Accordingly,it may be appropriate to extend the indications of fine needle aspiration for lateral lymph node in order to prevent missed diagnosis.