摘要目的 探讨临床颈淋巴结阴性(cN0期)甲状腺微小乳头状癌颈侧区淋巴结转移的临床特点及预防性清扫的意义以及可行性,为临床治疗提供参考.方法 回顾性分析2011年7月-2016年12月在连云港市东方医院普外科接受手术的191例cN0期甲状腺微小乳头状癌患者的临床资料,评估预防性颈侧区淋巴结清扫的必要性,采用x2检验及Logistic回归分析颈侧区淋巴结转移与患者的性别、年龄、肿瘤数目、肿瘤大小、包膜浸润、单双侧肿瘤、合并桥本病、中央区淋巴结转移的关系.结果 甲状腺微小乳头状癌颈侧区淋巴结转移阳性率为27.9％ (50/191),单因素分析发现,颈侧区淋巴结的转移与包膜浸润、合并桥本病、中央区淋巴结转移有关(均P ＜0.05);通过多变量Logistic回归分析可以表明包膜浸润(OR=7.563,P=0.000)、合并桥本病(OR=4.635,P=0.003)、中央区淋巴结转移(OR=3.075,P＜0.001)均能独立作为颈侧区淋巴结转移的危险因素,当中央区淋巴结转移阳性数目≥2枚时,颈侧区淋巴结阳性率显著增加(P＜0.001).11例(5.8％)暂时性喉返神经麻痹,29例(15.1％)暂时性甲状旁腺功能低下,无永久性喉返神经麻痹和甲状旁腺功能低下并发症患者.结论 颈侧区淋巴结的清扫有助于准确进行肿瘤的分期、分级以及危险度的评估,对患者术后治疗随访方案的选择有重要意义,对于包膜浸润、合并桥本病、中央区淋巴结转移的患者应常规行颈侧区淋巴结清扫.

abstractsObjective To discuss the clinical characteristics for lateral cervical lymph node metastasis in stage cN0 papillary thyroid microcarcinoma and significance and feasibility of preventive dissection,and provide reference for clinical treatment.Methods Reviewd the clinical data of 191 patients with stage cN0 papillary thyroid microcarcinoma patients from Jul.2011 to Dec.2016 underwent surgery in the Department of General Surgery of Lianyungang Oriental Hospital.Assessed the need for preventive cervical lymph node dissection.Chisquare test and logistic regression were used to analyze the relationship between cervical lymph node metastasis and gender,age,tumor number,tumor size,capsule infiltration,single and bilateral tumors,Hashimoto's disease,and central lymph node metastasis.Results The positive rate of cervical lymph node metastasis in papillary thyroid microcarcinoma was 27.9％ (50/191).Univariate analysis showed that the metastasis of the cervical lymph nodes was associated with infiltration of the capsule,Hashimoto disease,and CLN metastasis (all P ＜ 0.05).Multivariate logistic regression analysis showed that the capsule infiltration (OR =7.563,P =0.000),Hashimoto's disease (OR =4.635,P =0.003),and central lymph node metastasis (OR =3.075,P ＜ 0.001) were able to be independent risk factors for cervical lymph node metastasis.When the positive number of lymph node metastasis in the central region was ≥ 2,the positive rate of cervical lymph nodes was significantly increased (P ＜ 0.001).Eleven patients (5.8％) had temporary recurrent laryngeal nerve palsy,29 patients (15.1％) had transient hypoparathyroidism,and no patients with permanent recurrent laryngeal nerve palsy and hypoparathyroidism.Conclusions The removal of the cervical lymph nodes helps to accurately classify the tumor and assess the risk.It is important to choose the postoperative treatment follow-up plan for patients.For patients with capsule infiltration,Hashimoto's disease,and central lymph node metastasis,cervical lymph node dissection should be routinely performed.